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Treatment of resistant hypertension

INTRODUCTION

Resistant hypertension is defined as blood pressure that remains above goal in spite of concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic [1]. Patients whose blood pressure is controlled with four or more medications are considered to have resistant hypertension.

Patients with resistant hypertension are at high risk for adverse cardiovascular events and are more likely than those with controlled hypertension to have a secondary cause, which is usually at least in part reversible.

The treatment and prognosis of resistant hypertension that is not due to secondary causes will be reviewed here. 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. (See "Definition, risk factors, and evaluation of resistant hypertension" and "Who should be evaluated for renovascular or other causes of secondary hypertension?".)

DEFINITION AND GOAL BLOOD PRESSURE

Resistant hypertension is defined as blood pressure that remains above goal in spite of concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic [1]. Patients whose blood pressure is controlled with four or more medications are considered to have resistant hypertension.

The goal blood pressure is less than 140/90 mmHg in average risk hypertensive patients. There is evidence supporting a lower goal blood pressure in patients with atherosclerotic cardiovascular disease, diabetes mellitus, or chronic kidney disease. The supportive data are presented separately. (See "What is goal blood pressure in the treatment of hypertension?" and "Blood pressure management in patients with atherosclerotic cardiovascular disease", section on 'Goal blood pressure' and "Treatment of hypertension in patients with diabetes mellitus", section on 'Goal blood pressure' and "Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults", section on 'Blood pressure goal'.)

                

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Literature review current through: Jul 2014. | This topic last updated: Jun 24, 2014.
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