RT Book, Section
A1 Sutters, Michael
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1184192781
T1 Resistant Hypertension
T2 Current Medical Diagnosis & Treatment 2022
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264269389
LK accessmedicine.mhmedical.com/content.aspx?aid=1184192781
RD 2024/04/25
AB Resistant  hypertension  is  defined  as  the  failure  to  reach  blood  pressure  control  in  patients  who  are  adherent  to  full  doses  of  an  appropriate  three-drug  regimen  (including  a  diuretic).  Adherence  is  a  major  issue:  the  rate  of  partial  or  complete  noncompliance  probably  approaches  50%  in  this  group  of  patients;  doxazosin,  spironolactone,  and  hydrochlorothiazide  were  particularly  unpopular  in  one  Eastern  European  study  based  on  drug  assay.  In  the  approach  to  resistant  hypertension,  the  clinician  should  first  confirm  compliance  and  rule  out  “white  coat  hypertension,”  ideally  using  ambulatory  or  home-based  measurement  of  blood  pressure.  Exacerbating  factors  should  be  considered  (as  outlined  above).  Finally,  identifiable  causes  of  resistant  hypertension  should  be  sought  (Table  11–14).  The  clinician  should  pay  particular  attention  to  the  type  of  diuretic  being  used  in  relation  to  the  patient’s  kidney  function.  Aldosterone  may  play  an  important  role  in  resistant  hypertension  and  aldosterone  receptor  blockers  can  be  very  useful.  If  goal  blood  pressure  cannot  be  achieved  following  completion  of  these  steps,  consultation  with  a  hypertension  specialist  should  be  considered.  Renal  sympathetic  nerve  ablation  is  a  consideration  for  these  patients  in  the  absence  of  other  options,  but  further  trials  are  needed  before  this  procedure  can  be  routinely  integrated  into  clinical  practice.