Resistant hypertension

an overview

Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Despite the availability of anti-hypertensive medications with proven efficacy and good tolerability, many hypertensive patients have blood pressure levels(BP) not at the goals set by international societies. Some of these patients are either non-adherent to the prescribed drugs or not optimally treated. However, a proportion, despite adequate treatment, has resistant hypertension(RH) defined as office BP above goal despite the use of ≥3 antihypertensive medications at maximally tolerated doses (one ideally being a diuretic). Diagnosis of RH based upon office measurements, however, needs confirmation through 24-h BP monitoring to exclude "white coat" RH since cardiovascular events and mortality rates follow mean ambulatory BPs. Although several studies have approached the issue of the prevalence of RH in the hypertensive population, its prevalence is by and large based upon reasonable but approximate estimates for reasons detailed in the text. Standardized combination therapy based upon angiotensin converting enzyme inhibitors or angiotensin receptor blockers, amlodipine or other dihydropiridine calcium channel blockers and a diuretic (thiazide and thiazide-like compounds as cholrthalidone or indapamide) has been advocated to treat RH with spironolactone as fourth add-on drug. Interventional procedures such as renal denervation have been devised to treat RH and implemented in some patients with RH not responding to medical treatment. However, the results of this interventional procedure have insofar not been positive. It is unclear whether RH constitutes a specific phenotype of EH or should rather be considered a more serious form of uncontrolled hypertension. Whatever the case, its presence associates with and increased cardio- and cerebrovascular risk and deserves, therefore, particular care.

Original languageEnglish
JournalMinerva Cardioangiologica
DOIs
Publication statusE-pub ahead of print - Sep 5 2017

Fingerprint

Hypertension
Blood Pressure
Antihypertensive Agents
White Coat Hypertension
Indapamide
Thiazides
Sodium Chloride Symporter Inhibitors
Amlodipine
Spironolactone
Maximum Tolerated Dose
Angiotensin Receptor Antagonists
Calcium Channel Blockers
Denervation
Angiotensin-Converting Enzyme Inhibitors
Diuretics
Pharmaceutical Preparations
Therapeutics
Phenotype
Kidney
Mortality

Cite this

Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra (2017). Resistant hypertension: an overview. Minerva Cardioangiologica. https://doi.org/10.23736/S0026-4725.17.04495-4

Resistant hypertension : an overview. / Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra.

In: Minerva Cardioangiologica, 05.09.2017.

Research output: Contribution to journalArticle

Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra 2017, 'Resistant hypertension: an overview', Minerva Cardioangiologica. https://doi.org/10.23736/S0026-4725.17.04495-4
Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra. Resistant hypertension: an overview. Minerva Cardioangiologica. 2017 Sep 5. https://doi.org/10.23736/S0026-4725.17.04495-4
Società Italiana di Cardiologia, Sezione Regionale Tosco-Umbra. / Resistant hypertension : an overview. In: Minerva Cardioangiologica. 2017.
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AU - Cameli, Matteo

AU - Cerbai, Elisabetta

AU - Coiro, Stefano

AU - Emdin, Michele

AU - Liga, Riccardo

AU - Marcucci, Rossella

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AU - Palazzuoli, Alberto

AU - Padeletti, Luigi

AU - Savino, Ketty

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