Current approaches to the diagnosis and treatment of resistant hypertension

Abstract

Resistant hypertension (RHT) is a clinical state in which despite concomitant intake of at least three antihypertensive drugs, one of these preferably being a diuretic at full doses, blood pressure control can not be achieved. Priorly, it should be confirmed that the patients with resistant hypertension have true RHT which can be performed by ruling out factors associated with pseudo-resis-tance which include inaccurate measurement of blood presure (BP), inadequate treatment plan, non-adherence to prescribed therapy, or the white-coat effect. The complexity of the treatment regimen, socioeconomic status, lifestyle and psychological influences mainly effect compliance to treatment. Treatment methods being researched for the management of RHT include invasive, irreversible such as renal denervation and procedures applied using implantable devices as carotid baroreceptor stimulation. Because of inadequate number of data favouring renal denervation, it is unclear whether renal denervation may benefit a subset of patients with resistant hypertension. For this reason; the best choice for treatment of RHT seems to be full adherence to medication and life style change of patients with RHT.