Evaluation and treatment of resistant hypertension

ABSTRACT

Resistant hypertension is defined as blood pressure that remains uncontrolled in spite of use of three or more antihypertensive medications in effective doses, usually including a diuretic. Stricter goals, higher obesity rates, increase in life expectance, and increased use of exogenous substances are related to an increasing prevalence of resistant hypertension. The evaluation of patients with resistant hypertension is focused on identifying contributing and secondary causes of hypertension, such as hyperaldosteronism, obstructive sleep apnea, renal parenchymal disease, renal artery stenosis, and pheochromocytoma. Hyperaldosteronism is now recognized as the most common cause of resistant hypertension and all patients with resistant hypertension should be screened with a plasma aldosterone/renin ratio even if the serum potassium levelis normal. Treatment includes removal of contributing factors, appropriate treatment of secondary causes, and useof effective multi-drug regimens. Recent studies indicate that the addition of spironolactone to standard treatment regimens induces significant BP reduction in patients with resistant hypertension.