Resistant hypertension

Abstract

Background: Resistant hypertension is a common medical challenge facing clinicians and specialists. Although, the prevalence is currently unknown but various clinical trials have suggested that this problem is not rare. Resistant hypertension is blood pressure that remains above goal despite the use of at least three antihypertensive agents including a diuretic. It is a subtype of hypertension that increases the risk of cardiovascular, cerebrovascular and kidney disease. However, it is important to distinguish between pseudo-resistant hypertension and apparent hypertension from true resistant hypertension as they are often misdiagnosed.
 Objectives: This review focuses on resistant hypertension, its pathophysiology and established therapy.
 Methodology: Relevant articles used for this review covered a period of 2008-2022 using search engines and databases including PubMed, Scopus, Web of Science, and Google Scholar.
 Main observation: Evaluation of patients with true resistant hypertension includes appropriate blood pressure measurement, screening for causes of secondary hypertension and screening for interfering medications. Management of resistant hypertension that has proved successful includes non-pharmacological approach like lifestyle modification and optimization of pharmacological agents, often including the use of mineralocorticoid receptor antagonist.
 Conclusion: Considering the future management of resistant hypertension, a bunch of new device-based therapies are under effective development. Of these, renal denervation and carotid baroreflex activation are two potential devices for the significant reduction of blood pressure. However, further study is necessary before these devices can be approved for the routine treatment of resistant hypertension.
 Keywords: Aldosterone; Cardiovascular disease; Resistant Hypertension; Therapy.