Resistant Hypertension: Definition, Prevalence, and Cardiovascular Risk

Abstract

There is no uniform definition of resistant hypertension. The 2007 ESH-ESC guidelines for management of arterial hypertension used the term resistant hypertension when a therapeutic plan that has included attention to lifestyle measures and prescription of at least three drugs (including a diuretic) at adequate doses has failed to lower systolic and diastolic BP. Many patients who present with resistant hypertension actually have pseudoresistant hypertension. The exact prevalence of resistant hypertension is unknown. However, small studies estimate the prevalence from 5% in general medical practice up to 50% in nephrology clinics. A Spanish Ambulatory Blood Pressure Monitoring (ABPM) Registry found a 12.2% prevalence of resistant hypertension in the treated hypertensive population. Cardiovascular risk and prognosis of patients with resistant hypertension has not been specifically evaluated. They usually have a long-standing history of poorly controlled hypertension, and commonly have associated cardiovascular risk factors and target organ damage. Elevated ambulatory blood pressure predicts cardiovascular morbidity and mortality in resistant hypertensive patients whereas office blood pressure (BP) has no prognostic value.