Feature Article

Resistant hypertension – updates, issues and approach to management

Feature Article

Resistant hypertension – updates, issues and approach to management

CATHERINE BRUMBY, Kathryn Ducharlet, Robert MacGinley, Limy Wong

Figures

© realpeoplegroup/ istockphoto.com model used for illustrative purposes only
© realpeoplegroup/ istockphoto.com model used for illustrative purposes only

Abstract

Successful management of poorly controlled hypertension requires careful distinction of true resistant hypertension from other causes such as poor adherence to hypertension medications, undiagnosed secondary hypertension and white-coat hypertension. An individualised approach that includes modifying lifestyle and diet and optimising pharmacotherapies is recommended for patients with suspected resistant hypertension.

Key Points

  • Resistant hypertension is present when blood pressure remains elevated despite adherence to three or more antihypertensive medications at optimally tolerated doses (including a diuretic) and lifestyle modification.
  • White-coat hypertension and causes of secondary hypertension such as obstructive sleep apnoea and chronic kidney disease need to be excluded.
  • Both 24-hour ambulatory and home blood pressure self-monitoring are important diagnostic and management tools in suspected resistant hypertension.
  • Treatment of resistant hypertension comprises optimising lifestyle modifications such as lowering salt intake, weight loss and exercise, and using more aggressive pharmacotherapy with combinations of medications from different classes that also specifically include a diuretic. Specialist consultation may be required.
  • Techniques to improve patient engagement such as app-based technologies and home blood pressure self-monitoring may improve adherence to medication and lifestyle modifications.