Management of resistant hypertension A review

Abstract

Hypertension is a worldwide health problem, which is a greatest attributor for the burden of cardiovascular diseases when BP remains resistant or refractory to therapeutic measures. Despite the advanced development in the antihypertensive therapy, the incidence of resistant hypertension is estimated to be less than 5% of the hypertensive population. Resistant hypertension is defined as blood pressure that remains above the goal in spite of the concurrent use of 3 antihypertensive agents of different classes. It increases the risk of stroke, congestive heart failure, myocardial infarction, renal failure and retinal haemorrhage. Resistant hypertension is always multifactorial in etiology. Pseudoresistance includes poor medication adherence or white coat hypertension. Secondary causes of hypertension are common with resistant hypertension which includes obstructive sleep apnea syndrome, primary aldosteronism, pheochromocytoma, cushings syndrome, renal parenchymal disease, renal artery stenosis and diabetes. Successful management of resistant hypertension requires identification and reversal of life style factors, proper diagnosis and appropriate treatment of secondary causes of hypertension and use of effective multidrug regimens. The effective use of antihypertensive drugs reduces the occurrence of stroke by 30-40%, heart failure by 40-50%, coronary heart disease by 15% . The aim of antihypertensive therapy is to prevent morbidity and mortality associated with persistently raised BP by lowering it to an acceptable level, with minimum inconvenience to the patient. Therefore the need for earlier and comprehensive intervention in the management of resistant hypertension must be emphasized in attaining this goal.