Resistant Hypertension

Adv Exp Med Biol. 2017:956:181-189. doi: 10.1007/5584_2016_38.

Abstract

Conservatively, ten million people in the USA alone may suffer from RH and may be similarly prevalent elsewhere. Given the strong linear correlation between hypertension and cardiovascular outcomes, better control is paramount. We favor a multi-pronged approach. It may not suffice to address this by pharmacologic means only. Careful attention to modifiable risk factors, particularly sodium intake, adhering to a proper diet (i.e. DASH), and avoiding agents, i.e. non-steroidals, that can elevate the blood pressure, is key. Frequent follow up to establish the right treatment regimen and home blood pressuring monitoring can have a strong impact on control. Finally, consideration of device therapy may be a more viable option in the future.

Keywords: Carotid sinus baroreceptor electrical stimulation; Chronic kidney disease; Coarctation of aorta; Cushing syndrome; Hyperaldosteronism; Liddle syndrome; Obstructive sleep apnea; Pheochromocytoma; Renovascular hypertension; Resistant hypertension; Sympathectomy.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents / therapeutic use*
  • Baroreflex
  • Blood Pressure / drug effects*
  • Carotid Sinus / physiopathology
  • Drug Resistance*
  • Electric Stimulation Therapy / instrumentation
  • Humans
  • Hypertension / diagnosis
  • Hypertension / epidemiology
  • Hypertension / physiopathology
  • Hypertension / therapy*
  • Implantable Neurostimulators
  • Kidney / blood supply*
  • Protective Factors
  • Renal Artery / innervation
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior
  • Sympathectomy
  • Treatment Outcome

Substances

  • Antihypertensive Agents