Papel de la MAPA en el manejo de la hipertensión arterial resistente

Abstract

Hypertension is considered to be resistant when blood pressure goals (<140/90 mmHg in general, <130/80 mmHg in hypertensive patients with diabetes or renal disease) are not achieved by means of a triple-drug combination including a diuretic at full doses. In this situation, lack of therapeutic adherence, and causes of secondary hypertension must be excluded. The importance of ambulatory blood pressure monitoring (ABPM) in the management of resistant hypertension can be summarized in three points: a) ABPM-confirmation of true resistant hypertension allows false (“white-coat”) resistant hypertension (25–30% of cases with apparent resistant hypertension) to be excluded and consequently these patients do not required new antihypertensive agents to be added or complex complementary investigations to exclude secondary hypertension; b) as in other types of hypertension, the prognosis of patients with resistant hypertension is closely related to ambulatory blood pressure levels, as confirmed by several prospective studies, and c) a non-dipper pattern of nocturnal blood pressure confers a worse outcome profile.