Workup For Secondary Causes Research Articles

Review of resistant hypertension

Despite the prevalence of hypertension, blood pressure (BP) can be controlled with effective therapy in most patients. However, in a small percentage of the hypertensive population, BP remains refractory to therapeutic measures. In such patients who have so-called "resistant" hypertension, proper evaluation and assessment have to be undertaken to improve the BP control. There are some situations or factors that may make hypertension control difficult in some patients. Therefore, it is necessary to identify possible reasons for the loss of BP control and rectify them to achieve normotension. In addition to indicated work-up for secondary causes, aggressive treatment (nonpharmacologic and pharmacologic) of hypertension is required to prevent excessive morbidity and mortality in this special population.

Management of Refractory Hypertension

True refractory hypertension is unusual in clinical practice, thanks to the widespread availability of antihypertensive drugs and national mandate to optimize blood pressure control levels in the community. However, at times the blood pressure may become refractory to initial drug therapy. When the blood pressure levels do not reach a target level despite usual therapy, hypertension is considered refractory. There should be proper evaluation of such patients to determine the factor(s) responsible for resistance to therapy. In many patients, proper adjustment of drug doses, including effective use of diuretics, restores the blood pressure level. For some patients, potent drug therapy, such as hydralazine or minoxidil, must be considered. Based upon clinical course, work-up for secondary causes of hypertension should be considered in selected patients. Refractory hypertension requires proper analysis of etiologic factors and consideration of rational drug selection, and at times, work-up for secondary causes of hypertension.