Current concepts in the management of resistant hypertension: a review article

Abstract

Background: Resistant hypertension is defined as uncontrolled hypertension above the target goal despite treatment with 3 or more antihypertensive agents, one of which is a diuretic, at optimum and best tolerated doses. The target blood pressure is defined as < 140/90 mmHg in most people and < 130/80 mmHg in those with diabetes mellitus or Chronic Kidney disease.

Objective: To highlight the current trend in management of resistant hypertension.

Methods: Systematic review of existing literature on treatment resistant hypertension was carried out using original articles, review articles, case reports and Cochrane library data. All articles selected for inclusion in this review were evaluated critically with regards to their impact factor, source and evidenced based contribution on this topic as measured by their citation index and the journals they were published in.

Results: Pharmacologic management of resistant hypertension involves administration of ≥ 4 antihypertensive drugs from different classes, one of which is a diuretic, including the use of aldosterone antagonist when necessary. Recent advances in treatment of this condition includes the use of catheter based renal denervation therapy, the use of endothelin type A-receptor antagonist (Darusentan) and activating the Carotid Sinus Baroreflex mechanism.

Conclusion: Physicians should make efforts to differentiate between true resistant hypertension from pseudo-resistance. Referral to the Hypertension Specialist or a Cardiologist should be considered in patients whose hypertension is difficult to control despite adequate life style modifications and good adherence to optimum doses of recommended combinations of antihypertensive drugs.