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Adv Chronic Kidney Dis. 2019 Mar;26(2):99-109. doi: 10.1053/j.ackd.2019.03.002.

Resistant Hypertension: Diagnosis and Management.

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Department of Medicine, University of Iowa Hospital and Clinics, Iowa City, IA.
Division of Renal Diseases and Hypertension, Department of Medicine, University of Iowa Hospital and Clinics, Iowa City, IA. Electronic address:


Resistant hypertension is defined as high blood pressure requiring 3 or more medications for adequate control or controlled blood pressure requiring 4 or more medications. Considering the growing prevalence of hypertension and the strong link with cardiovascular disease, it is vital to understand the causes and treatment of resistant hypertension. This review article starts with an overview of the prevalence and little-known pathophysiology of resistant hypertension. Afterward, we discuss the evaluation and management of suspected secondary resistant hypertension in 2 broad categories: pseudoresistant hypertension and true resistant hypertension. Strategies for the identification and management of pseudoresistant hypertension are addressed. In addition, causes of true resistant hypertension, such as obstructive sleep apnea, primary aldosteronism, and renal artery stenosis, are examined along with their respective treatments. Finally, treatment of resistant hypertension is reviewed including pharmacologic treatments and novel procedural interventions for resistant hypertension. Overall, the review hopes to provide practitioners with a cohesive approach for the diagnosis and treatment of resistant hypertension.


Diagnosis; Hypertension; Resistant; Secondary; Treatment


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