Resistant Hypertension in Chronic Kidney Disease

Abstract

Resistant hypertension is defined as blood pressure that remains above 140/90 mmHg in spite of the continuous use of three antihypertensive agents in optimal dose, including diuretic, and lifestyle changes. Resistant hypertension needs to be discerned from pseudoresistance. Pseudoresistance is defined as lack of blood pressure control caused by inaccurate blood pressure measurement, inappropriate medication choice/dosage, lack of therapy compliance, or white-coat effect. The prevalence of resistant hypertension in Croatia is unknown. According to data from USA and Europe, the prevalence of resistant hypertension ranges from 10 up to 30 in patients with diagnosed hypertension. Numerous biological and lifestyle factors can contribute to the development of resistant hypertension: medications (nonsteroidal anti-inflammatory drugs, sympathomimetics, illicit drugs, oral contraceptives, cyclosporine and tacrolimus), adrenal steroid hormones, erythropoietin, licorice, excess alcohol intake, volume overload, obesity, diabetes mellitus, chronic kidney disease, older age, renal parenchymal disease, renovascular disease, primary aldosteronism, obstructive sleep apnea, pheochormocytoma, Cushing's syndrome, thyroid diseases, aortic coarctation and intracranial tumors. For diagnosing patient's history is important, assessing compliance, regular blood pressure measurement, physical examination, ambulatory blood pressure monitoring, biochemical evaluation and noninvasive imaging. The resistant hypertension treatment is achieved with nonpharmacological measurements (lifestyle changes, compliance improvement and excluding of medications affecting blood pressure), pharmacological measurements ( combined therapy, mineralocorticoid antagonists), treating secondary hypertension causes, and invasive procedures.