Treatment of resistant hypertension
- David A Calhoun, MD
David A Calhoun, MD
- Professor of Medicine
- University of Alabama at Birmingham
- Raymond R Townsend, MD
Raymond R Townsend, MD
- Professor of Medicine
- Perelman School of Medicine
- University of Pennsylvania
- Section Editors
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- William B White, MD
William B White, MD
- Section Editor — Hypertension
- Professor of Medicine
- Chief, Hypertension and Clinical Pharmacology
- Calhoun Cardiology Center
- University of Connecticut School of Medicine, Farmington
- Past President
- American Society of Hypertension 2012-2014
- Blood Pressure Monitoring
Resistant hypertension is defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic . 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 "Evaluation of secondary hypertension".)
DEFINITION AND GOAL BLOOD PRESSURE
Resistant hypertension is defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic (selected based upon kidney function) [1,2]. Patients whose blood pressure is controlled with four or more medications are considered to have resistant hypertension.
Goal blood pressure in patients with resistant hypertension is discussed in other topics. (See "What is goal blood pressure in the treatment of hypertension?" and "Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults", section on 'Blood pressure goal'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- DEFINITION AND GOAL BLOOD PRESSURE
- GENERAL PRINCIPLES
- Identify and treat secondary hypertension
- Stop medications that raise the blood pressure
- Refer to a hypertension specialist
- Out-of-office blood pressure monitoring
- NONPHARMACOLOGIC THERAPY
- PHARMACOLOGIC THERAPY
- Mineralocorticoid receptor antagonists
- CHOICE OF REGIMEN
- EXPERIMENTAL THERAPIES
- Catheter-based radiofrequency ablation of renal sympathetic nerves
- Electrical stimulation of carotid sinus baroreceptors
- Central arteriovenous anastomosis
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS