Management of Resistant Hypertension

Abstract

“Resistant” hypertension has been variously defined, but most authors accept a definition that includes a blood pressure ≥140/90 mm Hg after prescription of a diuretic and typically two other appropriately chosen antihypertensive drugs at near-maximal doses. Patients with resistant hypertension are of great public health importance because they have a high absolute cardiovascular and renal risk, greater health care expenditures, a higher prevalence of secondary hypertension and target-organ damage, and are, by definition, more “difficult to control” than hypertensive patients who are controlled with only one or two medications. Centers that specialize in these patients report that more than 90% can be diagnosed with a specific cause of their treatment resistance, and more than 50% can be controlled in a relatively short time after an appropriate intervention. This article reviews the differential diagnosis, evaluation, and outcomes of treatment paradigms for such patients, and emphasizes the role of hypertension specialists in their management.