Identification and management of resistant hypertension
DOI:
https://doi.org/10.18203/2320-6012.ijrms20212333Keywords:
Resistant hypertension, Antihypertensive agents, HypertensionAbstract
Resistant hypertension is defined as blood pressure being higher than the patient's target blood pressure despite the use of three or more different types of antihypertensive drugs at the optimal dose, and one of them should be a diuretic. The evaluation of patients with resistant hypertension should first confirm that they have true resistant hypertension. By eliminating or correcting false resistance factors, such as white coat hypertension, poor blood pressure measurement technique, poor drug compliance, improper dosage or combination of antihypertensive drugs, and white coat effects and clinical inertia. Resistant hypertension therapy includes improved compliance with the use of drugs, secondary hypertension detection and treatment, use of lifestyle measures and treatment of obesity, and other comorbidities. switching to a long-acting diuretic type of thiazide like chlorthalidone could improve the BP from the patients taking hydrochlorothiazide. This review paper illustrates briefly the identification of the underlying causes of resistant hypertension and therapeutic strategies, which may contribute to the proper diagnosis and an improvement of the long term management of resistant hypertension.
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References
GBD. Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390:1345-422.
Persell SD. Prevalence of resistant hypertension in the United States, 2003–2008. Hypertension. 2011;57:1076-80.
Sarafidis PA, Georgianos P, Bakris GL. Resistant hypertension- its identification and epidemiology. Nat. Rev. Nephrol.2013; 9:51-8.
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M et al. 2013 ESH/ ESC practice guidelines for the management of arterial hypertension. Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and the European Society of Cardiology. Blood Press. 2014;23(1):3-16.
WC Cushman, CE Ford, JA Cutler. Success and predictors of blood pressure control in diverse North American settings: the antihypertensive and lipid-lowering treatment to prevent heart attact trial (ALLHAT),” Journal of Clinical Hypertension. 2002;4(6):393-404.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Coillins KJ, Dennison Himmelfarb C et al. 2017 ACC/AHA/AAPA/ABC/ ACPM/AGS/APhA/ASH ASPC/NMA/PCNA guideline for the prevention, detection, evaluation and management of high blood pressure in adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127-248.
Tanner RM, Calhoun DA, Bell EK, Bowling CB, Gutierrez OM, Irvin MR et al. Prevalence of apparent treatment-resistant hypertension among individuals with CKD. Clin JAm Soc Nephrol. 2013;8:1583-90.
Thomas G, Xie D, Chen HY, Anderson AH, Appel LJ, Bodana S et al. Study Investigators. Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: report from the Chronic Renal Insufficiency Cohort Study. Hypertension. 2016;67:387-96.
Muntner P, Davis BR, Cushman WC, Bangalore S, Calhoun DA, Pressel SL et al. For the ALLHAT Collaborative Research Group. Treatment-resistant hypertension and the incidence of cardiovascular disease and end-stage renal disease: results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension. 2014;64:1012-21.
Pimenta E, Calhoun DA. Resistant hypertension: incidence, prevalence, and prognosis. Circulation. 2012;125:1594-6.
National Clinical Guideline Centre. National Institute for Health and Clinical Excellence: Guidance. Hypertension: the clinical management of primary hypertension in adults: update of clinical Guidelines 18 and 34. London: Royal College of Physicians (UK) National Clinical Guideline Centre. 2011.
Gwadry-Sridhar FH, Manias E, Lal L, Salas M, Hughes DA, Ratzki- Leewing A et al. Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: a systematic review by the ISPOR medication adherence and persistence special interest group. Value Health. 2013;16:863-71.
Daugherty SL, Powers JD, Magid DJ. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012;125:1635-42.
Burnier M, Wuerzner G, Struijker- Boudier H, Urquhart JJ. Measuring, analyzing, and managing drug adherence in resistant hypertension. Hypertension. 2013;62:218-25.
Morisky DE, Ang A, Krousel- Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting.j.Clin. Hypertens. 2008;10:348-54.
Jacobs L. Results of a randomized controlled pilot trial of intravascular renal denervation for management of treatment- resistant hypertension. Blood Press. 2017;26:321-31.
Correa NB, de Faria AP, Ritter AM, Sabbatini AR, Almeida A, Brunelli V et al. A practical approach for measurement of antihypertensive medication adherence in patients with resistant hypertension. J Am Soc Hypertens. 2016;10:510-6.
Bangalore S, Kamalakkannan G, Parkar S, Messerli FH. Fixed-dosecombinations improve medication compliance: a meta-analysis. Am JMed. 2007;120:713-9.
Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23:1296-310.
Bhatt H, Siddiqui M, Judd E, Oparil S, Calhoun D. Prevalence of pseudoresistant hypertension due to inaccurate blood pressure measurement. J Am Soc Hypertens. 2016;10:493-9.
Carey RM, Calhoun DA, Bakris GL, et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension. 2018;72(5):e53-e90.
CL Trewet, ME Ernst. Resistant hypertension: identifying causes and optimizing treatment regimens. Southern Medical Journal. 2008;101(2):166-73.
Benjamin EJ, Muntner P, Alonso A. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56-28.
Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:10-29.
Hall JE. The kidney, hypertension, and obesity. Hypertension. 2008;41(3):625-33.
Kroon B. European Society of Hypertension 20th Meeting. Abstract 01, Oral Session 9D.
Calhoun DA, Jones D, Textor S. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement fromthe American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117(25):e510-26.
Calhoun DA. Resistant or difficult-to-treat hypertension. Journal of Clinical Hypertension. 2008;8(3):181-6.
White WB, Turner JR, Sica DA, Bisognano JD, Calhoun DA, Townsend RR et al. Detection, evaluation and treatment of severe and resistant hypertension: proceedings from an American Society of Hypertension Interactive Forum held in Bethesda, MA, U.S.S., October 10th 2013. J Am Soc Hypertens. 2014;8:743-57.
Shimbo D, Levitan EB, Booth JN. The contributions ofunhealthy lifestyle factors to apparent resistant hypertension: findings from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Hypertension. 2013;31:370-6.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Coillins KJ, Himmelfarb DC, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH ASPC/NMA/PCNA guideline for the prevention, detection, evaluation and management of high blood pressure in adults. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127-248.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA. 2003;289:2560-72.
Ernst ME, Carter BL, Geordt CJ, Steffensmeier JJ, Phillips BB, Zimmerman MB, et al. Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure. Hypertension. 2006;47:352-8.
Sarafidis PA, Bakris GL. Resistant hypertension: an overview of evaluation and treatment. J Am Coll Cardiol. 2008;52:1749-57.
Williams B, MacDonald TM, Morant S. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. The Lancet. 2015;386:2059-68.
Khawaja Z, Wilcox CS. Role of the Kidneys in resistant hypertension. Int J Hypertens. 2011;2011:1-8.
British Cardiac Society. JBS 2: joint British societies’ guidelines on prevention of cardiovascular diseases in clinical practice. Heart. 2005;91:1-52.
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