Treatment of resistant hypertension is a priority because patients with nonoptimal blood pressure are at high risk for major cardiovascular events. Pharmacological advances include the use of aldosterone antagonists and the development of several new strategies. Device-based therapies such as catheter-based renal denervation and electrical stimulation of baroreceptors are showing promising results.
- Resistant hypertension is blood pressure above target levels despite adherence to lifestyle modification and treatment with at least three antihypertensive agents at optimal doses.
- Contributing lifestyle factors and potentially reversible causes should be identified and treated.
- Medications and other substances interfering with efficacy of antihypertensives should be discontinued or minimised.
- Beta blockers, α-blockers, centrally acting sympatholytic agents and direct vasodilators are fourth-line treatments.
- Many experts now consider aldosterone antagonists a fourth-line treatment.
- Potential pharmacological strategies include aldosterone synthase inhibitors, neutral endopeptidase inhibitors and endothelin receptor antagonists.
- The device-based therapy catheter-based renal denervation is available in Australia.