What is refractory hypertension?
Refractory hypertension is defined as uncontrolled blood pressure despite use of ≥5 antihypertensive agents of different classes, including a long-acting thiazide-like diuretic and an MR (mineralocorticoid receptor) antagonist, at maximal or maximally tolerated doses.
What are the causes of resistant hypertension?
Most common secondary causes of resistant hypertension are obstructive sleep apnea, renal artery stenosis, renal parenchymal disease, and primary aldosteronism while some uncommon causes such as pheochromocytoma, Cushing’s disease, thyroid and parathyroid dysfunction; and aortic coarctation also contribute to resistant …
What is resistant high blood pressure?
You’re taking a diuretic and at least two other blood pressure medicines. But your blood pressure still isn’t budging. This is called resistant hypertension. Simply put, it means that your high blood pressure (HBP or hypertension) is hard to treat and may also have an underlying (secondary) cause.
What is the treatment of resistant hypertension?
If you have been taking your medication correctly and still have resistant hypertension, your doctor may choose to add another medication. The most common classes of blood pressure medicines are diuretics, calcium channel blockers, and ACE inhibitors/angiotensin receptor blockers (ARBs).
Why is spironolactone used in resistant hypertension?
Spironolactone is recommended in patients with resistant hypertension which is defined as uncontrolled blood pressure despite three antihyperternsive drug combination including a diuretic. Spironolactone is a mineralocorticoid receptor antagonist and causes anti-androgenic side effects.
Is refractory hypertension the same as resistant hypertension?
Recently, refractory hypertension has been proposed to refer specifically to antihypertensive treatment failure. As such, it would represent an extreme phenotype of resistant hypertension, referring specifically to elevated blood pressure (BP) that is not controlled in spite of the use of maximal medical therapy.
How do you manage refractory hypertension?
How is resistant hypertension treated?
- Limiting salt and alcohol.
- Limiting use of NSAIDs for pain relief (acetaminophen can be used instead).
- Doing at least 30 minutes a day of aerobic activity several days a week.
- Treating sleep apnea with continuous positive airway pressure.
What is the treatment for resistant hypertension?
Treatment of resistant hypertension is focused on the addition of fourth-line therapy where blood pressure is not controlled by treatment with three drugs, described by NICE as A+C+D: that is, an ACE inhibitor or an angiotensin II receptor blocker (A), a calcium channel antagonist (C), and a thiazide or thiazide-like …
How do you beat resistant hypertension?
Management includes lifestyle and dietary modification, elimination of medications contributing to resistance, and evaluation of potential secondary causes of hypertension. Pharmacological treatment should be tailored to the patient’s profile and focus on the causative pathway of resistance.
Can resistant hypertension reversed?
Resistant hypertension has several possible causes, including another underlying medical condition, but many of those causes are reversible.
How is resistant hypertension diagnosed?
The diagnosis of resistant hypertension requires use of good blood pressure technique to confirm persistently elevated blood pressure levels. Pseudoresistance, including lack of blood pressure control secondary to poor medication adherence or white coat hypertension, must be excluded.