Abstract
Resistant hypertension is common and known to be a risk factor for cardiovascular events, including stroke, myocardial infarction, heart failure, and cardiovascular mortality, as well as adverse renal events, including chronic kidney disease and end-stage kidney disease. This review will discuss the definition of resistant hypertension as well as the most recent evidence regarding its diagnosis, evaluation, and management. The issue of medication non-adherence and its association with apparent treatment-resistant hypertension will be addressed. Non-pharmacological interventions for the treatment of resistant hypertension will be reviewed. Particular emphasis will be placed on pharmacological interventions, highlighting the role of mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors and device therapy, including renal denervation, baroreceptor activation or modulation, and central arteriovenous fistula creation.
Highlights
Resistant hypertension (RH) is usually defined as blood pressure (BP) that remains above guideline-specified targets despite the use of three or more antihypertensive agents at optimal or maximally tolerated doses, with one of those agents preferably being a diuretic
Are accurate and standardized office BP measurements important in the diagnosis of RH, out-of-office measurements, usually with a 24-h ambulatory blood pressure monitoring (ABPM), are crucial to rule out white-coat hypertension, which, in one study [7], was present in 37.5% of patients diagnosed with RH on the basis of office BP measurements
Pharmacological management of hypertension traditionally includes the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide-like diuretics as first-line
Summary
Resistant hypertension (RH) is usually defined as blood pressure (BP) that remains above guideline-specified targets despite the use of three or more antihypertensive agents at optimal or maximally tolerated doses, with one of those agents preferably being a diuretic (see Table 1). It is not uncommon, being identified in 10 to 30% of hypertensive patients [1], and it is known to be a risk factor for cardiovascular (CV) events, including stroke, myocardial infarction (MI), heart failure (HF), and CV mortality, as well as adverse renal events, including chronic kidney disease (CKD) and end-stage kidney disease (ESKD) [2–5]. Based on a recent systematic review [6], the prevalence of apparent treatment-RH has been estimated at 14.7% of all hypertensive patients, while the prevalence of true RH has been estimated at only 10.3% of those same patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
