According to one definition ineffective treatment with 3 or more antihypertensive drugs including diuretics makes it possible to diagnose resistant. What is the treatment for resistant hypertension high blood. Treatment with firstline agents should be expeditious and occur as soon as possible within 3060 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. Renal sympathetic denervation in patients with treatment. Medication adherence and resistant hypertension journal. Resistant hypertension high blood pressure thats hard to. Objective to assess blood pressure bp control, antihypertensive treatment, and prevalence of resistant hypertension rh in patients with type 1 diabetes stratified by stage of diabetic nephropathy. Patients with trh had a heightened risk for adverse longterm outcomes, especially nonfatal stroke and congestive heart failure.
Recent guidelines have defined resistant hypertension rht as blood pressure bp that does not fall below 14090 mmhg, despite a therapeutic strategy that includes appropriate lifestyle measures, plus a diuretic and two other antihypertensive drugs belonging to different classes at adequate doses. Consider further diuretic therapy with lowdose spironolactone. Resistant hypertension is defined as uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. Common secondary causes of resistant hypertension and. The numbers in this study alone are too small to undertake a meaningful analysis of potential predictors. Recommendations for the management of patients with resistant hypertension. Evaluation of possible rh begins with an assessment of adherence to medications. Be able to make optimal treatment decisions for hypertensive patients 3. Knowledge and management of resistant hypertension rht has matured in recent years with the help of new epidemiological data, wider application of outofoffice bp measurements and the introduction of interventional treatments. Pdf hypertension resistant to lifestyle interventions and antihypertensive medications is a. Emerging evidence suggests that multiple mechanisms may be responsible for the development of treatmentresistant hypertension trh. Surgeons once attempted to relieve hypertension by severing these renal artery nerves, which resulted in lowering blood pressure too far. Nationally recognized expertise in treating resistant hypertension and minimizing the harm it causes precise diagnosis to identify the type and root causes of your hypertension, including advanced home monitoring devices to track your blood pressure over a longer period of time teambased planning for challenging cases that brings together experts in nephrology, cardiology, endocrinology. Feldman rd, zou gy, vandervoort mk, wong cj, nelson sa, feagan bg.
Renal sympathetic denervation in patients with treatmentresistant hypertension the symplicity htn2 trial. Over 16 000 subjects had hypertension, with 2654 meeting the definition of apparent treatmentresistant hypertension1547 by taking three drugs without achieving control and 1107 by 4. Methods we conducted a search in pubmed, embase, web of science and global index medicus to identify articles published from inception to 30 september 2017. Definition aha scientific statement hypertension 2008.
Medication adherence and treatmentresistant hypertension. Resistant hypertension is a severe medical condition which is estimated to appear in 918% of hypertensive patients. As defined, resistant hypertension includes patients whose blood pressure is controlled with use of more than 3 medications. Treatment resistant hypertension trh has been defined as bp above goal on. Prevalence of resistant hypertension is increasing. Percutaneous renal denervation in patients with treatment. Excess sodium and fluid retention, increased activation of the reninangiotensinaldosterone.
Apparent atrh is used when optimal therapy, adherence, and measurement artifacts are unknown. Because hypertension is largely managed with drug therapy, clinical pharmacists often participate in management, especially when hypertension may be difficult to manage because of factors such as adverse effects or resistant hypertension. The definition, prevalence, risk factors, and evaluation of resistant hypertension and secondary causes of hypertension, such as renovascular disease and primary aldosteronism, are discussed elsewhere. Detection, evaluation, and management of high blood pressure in adults bp 5 back to table of contents of. In another study, however, of ambulatory and office blood pressures after rdn in patients with treatment resistant hypertension, office systolic blood pressure at baseline was the only independent correlate of response. New drugs and device therapy are currently under investigation for treatment of resistant hypertension 17. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in highrisk patients.
Treatment of resistant and refractory hypertension aha journals. Apparent a trh is used when optimal therapy, adherence, and measurement artifacts are unknown. Results among all those with hypertension regardless of treatment status, control of blood pressure was achieved in 22% of men kyh and tromso 7, while among women it. Symptoms of resistant hypertension stanford health care. Renal sympathetic denervation in patients with treatment resistant hypertension the symplicity htn2 trial. Only 3% were receiving chlorthalidone hydone, generic, a diuretic water pill that several. Resistant hypertension is defined as high blood pressure that remains uncontrolled despite treatment with at least three antihypertensive agents one of which is usually a diuretic at best tolerated doses. This is currently recommended for the treatment of patients with clinic systolic bp persistently. How effective is spironolactone for treating resistant. Emergent therapy for acuteonset, severe hypertension during. Diagnosis and management of resistant hypertension heart. Resistant hypertensionfailure to reach target blood pressure in persons who adhere to an appropriate 3drug regimen including a diureticis increasing in prevalence.
A 2016 metaanalysis of 5 rcts with a total of 553 patients examined the effectiveness of addon treatment with spironolactone 2550 mgd for patients with resistant hypertension, defined as failure to achieve bp treatment with 3 or more bplowering drugs, including one diuretic. The prevalence of trh in the study varied between 6. A diagnosis of true resistant hypertension should be made only after a thorough assessment to exclude apparent or pseudoresistant hypertension. Which drugs work best for resistant high blood pressure. Second, as apparent treatment resistant hypertension atrh, i. A diagnosis of true resistant hypertension should be made only after a thorough assessment to exclude apparent or pseudo resistant hypertension. The whitecoat effect should be ruled out by out of office blood pressure monitoring.
Resistant hypertension is most often due to insufficient medical therapy. Sometimes that means wearing a pagersized automatic blood pressure recorder for 24 hours or checking pressure with an athome monitor several times a day. Emerging evidence suggests that multiple mechanisms may be responsible for the development of treatment resistant hypertension trh. Characteristics of resistant hypertension in a large, ethnically diverse hypertension population of an integrated health system. Resistant hypertension occurs when blood pressure stays high despite taking three or more drugs, or when a person needs four or more drugs to reach blood pressure goals. The whitecoat effect should be ruled out by outofoffice blood pressure monitoring. Excess sodium and fluid retention, increased activation of the reninangiotensin. Pdf diagnosis and treatment of resistant hypertension. Medication adherence and resistant hypertension journal of. Resistant hypertension advances in chronic kidney disease.
Diagnosis and management of resistant hypertension. Resistant hypertension rh has a prevalence of around 12% and is. Resistant hypertension rh is defined as blood pressure above a goal despite adherence to at least 3 optimally dosed antihypertensive medications of different classes, one of which is a diuretic. Renal denervation is a new treatment for resistant hypertension that targets the nerves near the kidneys responsible for regulating blood pressure. Nov 20, 2012 resistant hypertension is defined as high blood pressure that remains uncontrolled despite treatment with at least three antihypertensive agents one of which is usually a diuretic at best tolerated doses. Dedicated followup care to support your treatment and help keep your blood pressure in check. The chart showing pdf series, word series, html series, scan qr codes.
Resistant hypertension is defined as blood pressure bp that remains above goal in spite of use of three antihypertensive medications in effective doses, usually. Nov 17, 2010 symplicity htn2 was an international, multicentre, randomised study of the safety and effectiveness of renal denervation in patients with treatmentresistant hypertension. Addon treatment with spironolactone also reduces bp. Resistant hypertension american board of family medicine.
Recognition and treatment of secondary causes of hypertension among patients with resistant hypertension may help to control blood pressure and reduce cardiovascular risk. New recommendations for the detection, evaluation, and management of hypertension have been published in. Resistant hypertension is a common clinical problem faced by both primary care clinicians and specialists. Uncontrolled and apparent treatment resistant hypertension. While the exact prevalence of resistant hypertension is unknown, clinical trials suggest that it is not rare, involving perhaps 20% to 30% of study participants. Standard treatment regimens consist of selecting not only from a variety.
New perspectives in diagnosis and treatment of resistant. Assess treatment effect monthly until goal bp is reached if goal bp cannot be reached, consider adding other classes of drugs or referral to a hypertension specialist jama 311. Methods we conducted a search in pubmed, embase, web of science and global index medicus to identify articles published from inception to 30. Due to higher cardiovascular risk, this disorder requires special diagnosis and. Underlying causes and treatment article pdf available in arzneimittelforschungdrug research 635. Mechanisms and treatment of resistant hypertension scielo. For people with confirmed resistant hypertension, consider adding a fourth antihypertensive drug as step 4 treatment see below or seeking expert advice. Treatment resistant hypertension in a communitybased practice network abstract. Advanced treatment for resistant hypertension, including a thorough reevaluation of your existing care plan, medication and lifestyle changes, and new minimally invasive treatments. If hypertension is not controlled in adults taking the optimal tolerated doses of an ace inhibitor or an arb plus a ccb and a thiazidelike diuretic, regard them as having resistant hypertension. Treatment resistance can be attributed to poor adherence to antihypertensive drugs, excessive salt intake, physician inertia, inappropriate or inadequate medication, and secondary hypertension. Of 8,295 people included in the study, 37% of those who were believed to have treatmentresistant hypertension actually had white coat hypertension. Population with ckd, initial or addon therapy should include and acei or arb to improve.
Resistant hypertension rhtn is defined as high blood pressure bp in a hypertensive patient that remains a bove goal despite use of. Causes of resistant hypertension stanford health care. It highlights situations, such as pseudohypertension, that may masquerade as resistance, and it identifies drugs that may aggravate blood. General black population including diabetes initial treatment should include a thiazide diuretic or calcium channel blocker 8. What is the treatment for resistant hypertension high. Monitoring and treatment of resistant hypertension. Treatment resistant hypertension trh is defined by office blood pressure bp uncontrolled on. Resistant hypertension is generally defined as uncontrolled clinic blood pressure 14090 mm hg after treatment with three or more antihypertensives.
Reining in blood pressure levels begins with the basics, such as understanding your pressure patterns. We showed that in patients with trh, after optimisation of antihypertensive therapy, exclusion of secondary causes of hypertension, and wce, only half of the patients were truly treatment resistant. Sep 11, 2014 over 16 000 subjects had hypertension, with 2654 meeting the definition of apparent treatmentresistant hypertension1547 by taking three drugs without achieving control and 1107 by 4 or more. See page e194, treatment of resistant hypertension. Resistant hypertension is defined in order to identify patients who are at high risk of having reversible causes of hypertension and who may benefit from special diagnostic and therapeutic considerations. That is, patients whose blood pressure is controlled, but required 4 or more medications to do so, should be considered resistant to treatment. Patients aged 1885 years with a systolic blood pressure of 160 mm hg or more.
Before considering further treatment for a person with resistant hypertension. Due to higher cardiovascular risk, this disorder requires special diagnosis and treatment. Hypertension epidemiology the prevalence of hypertension in u. Antihypertensive treatment and resistant hypertension in. Research design and methods this crosssectional study included a nationally representative cohort of patients with type 1 diabetes n 3,678 from the finnish diabetic. Be aware of the comprehensive approach needed to prevent cardiovascular disease. What is new in the management of resistant hypertension. Intravenous labetalol and hydralazine have long been considered firstline medications for the management of acuteonset, severe hypertension in pregnant women and. New recommendations for the detection, evaluation, and management of hypertension have been published in the 2017.
1363 96 1063 1295 206 892 1070 603 1512 572 701 1214 755 71 1392 1372 1438 738 1575 210 306 992 346 1667 1085 1280 1084 245 729 9 876 373 510 795 361 1320 136 1285 892 722