Prakt. Lékáren. 2019; 15(1e): 36-40 [Interní Med. 2018; 20(4): 167-170]

Latest developments in the management of resistant hypertension

Renata Cífková

Centrum kardiovaskulární prevence 1. LF UK a TN, Praha

Hypertension resistant to treatment is currently defined as a situation when the recommended treatment strategy fails to lower office blood
pressure to values < 140/90 mmHg, and inadequate control of blood pressure is confirmed by ambulatory blood pressure monitoring or home
blood pressure measurement. The recommended treatment strategy should include treatment with optimal or best-tolerated doses of three or more drugs that should include a diuretic and, typically, an ACE inhibitor or angiotensin receptor blocker and a calcium-channel blocker. The
estimated prevalence using the above definition is likely to be < 10% of treated patients. Pseudoresistant hypertension and secondary causes
of hypertension should be excluded. The recommended treatment strategy should include treatment with optimal or best-tolerated doses
of three or more drugs that should include a diuretic and, typically, an ACE inhibitor or angiotensin receptor blocker and a calcium-channel
blocker. The fourth-line treatment should include spironolactone (up to 50 mg a day). Fixed combinations are preferred.

Keywords: pseudoresistant hypertension, ACE inhibitors, angiotensin receptor blockers, secondary hypertension, 24h ambulatory BP monitoring,home BP measurement

Published: March 15, 2019  Show citation