Evaluation and management of the patient with difficult-to-control or resistant hypertension.

Published

Journal Article (Review)

High blood pressure is often difficult to control. Resistant hypertension is blood pressure above goal despite adherence to a combination of at least three antihypertensive medications of different classes, optimally dosed and usually including a diuretic. The approach to blood pressure that is apparently difficult to control begins with an assessment of the patient's adherence to the management plan, including lifestyle modifications and medications. White-coat hypertension may need to be ruled out. Suboptimal therapy is the most common reason for failure to reach the blood pressure goal. Once-daily fixed-dose combination pills may improve control through the synergism of antihypertensive agents from different classes and improved adherence. Truly drug-resistant hypertension is commonly caused by chronic kidney disease, obstructive sleep apnea, or hyperaldosteronism, all of which can lead to fluid retention. Higher doses of diuretics (or a change to a loop diuretic) are usually needed. Other strategies include adding an alpha blocker, alpha-beta blocker, clonidine, or an aldosterone antagonist (e.g., spironolactone). Particularly in patients with diabetes or renal disease, combining a long-acting nondihydropyridine with a dihydropyridine calcium channel . blocker can also be considered. Obesity, heavy alcohol intake, high levels of dietary sodium, and interfering substances (especially nonsteroidal anti-inflammatory drugs) contribute to hypertension that is resistant or difficult to control.

Full Text

Duke Authors

Cited Authors

  • Viera, AJ; Hinderliter, AL

Published Date

  • May 2009

Published In

Volume / Issue

  • 79 / 10

Start / End Page

  • 863 - 869

PubMed ID

  • 19496385

Pubmed Central ID

  • 19496385

Electronic International Standard Serial Number (EISSN)

  • 1532-0650

International Standard Serial Number (ISSN)

  • 0002-838X

Language

  • eng