Recognition and Management of Resistant Hypertension.
Despite improvements in hypertension awareness and treatment, 30%-60% of hypertensive patients do not achieve BP targets and subsequently remain at risk for target organ damage. This therapeutic gap is particularly important to nephrologists, who frequently encounter treatment-resistant hypertension in patients with CKD. Data are limited on how best to treat patients with CKD and resistant hypertension, because patients with CKD have historically been excluded from hypertension treatment trials. First, we propose a consistent definition of resistant hypertension as BP levels confirmed by both in-office and out-of-office measurements that exceed appropriate targets while the patient is receiving treatment with at least three antihypertensive medications, including a diuretic, at dosages optimized to provide maximum benefit in the absence of intolerable side effects. Second, we recommend that each patient undergo a standardized, stepwise evaluation to assess adherence to dietary and lifestyle modifications and antihypertensive medications to identify and reduce barriers and discontinue use of substances that may exacerbate hypertension. Patients in whom there is high clinical suspicion should be evaluated for potential secondary causes of hypertension. Evidence-based management of resistant hypertension is discussed with special considerations of the differences in approach to patients with and without CKD, including the specific roles of diuretics and mineralocorticoid receptor antagonists and the current place of emerging therapies, such as renal denervation and baroreceptor stimulation. We endorse use of such a systematic approach to improve recognition and care for this vulnerable patient group that is at high risk for future kidney and cardiovascular events.
['Braam|Branko|B|', 'Taler|Sandra J|SJ|', 'Rahman|Mahboob|M|', 'Fillaus|Jennifer A|JA|', 'Greco|Barbara A|BA|', 'Forman|John P|JP|', 'Reisin|Efrain|E|', 'Cohen|Debbie L|DL|', 'Saklayen|Mohammad G|MG|', 'Hedayati|S Susan|SS|']
D000959:Antihypertensive Agents D003329:Coronary Vasospasm D004032:Diet D004232:Diuretics D004359:Drug Therapy, Combination D004599:Electric Stimulation Therapy D006801:Humans D006973:Hypertension D008019:Life Style D000451:Mineralocorticoid Receptor Antagonists D010349:Patient Compliance D051436:Renal Insufficiency, Chronic D013562:Sympathectomy
hypertension diuretics Mineralocorticoid Receptor Antagonists Denervation kidney Antihypertensive Agents Humans Life Style Pressoreceptors Renal Insufficiency, Chronic blood pressure cardiovascular disease chronic kidney disease renal denvervation sodium intake