Resistant hypertension-defining the scope of the problem

Prog Cardiovasc Dis. 2020 Jan-Feb;63(1):46-50. doi: 10.1016/j.pcad.2019.12.006. Epub 2019 Dec 19.

Abstract

The updated scientific statement by the American Heart Association has defined resistant hypertension (HTN;RH) as uncontrolled blood pressure (BP) ≥ 130/80 mmHg, despite concurrent use of 3 anti-HTN drug classes comprising a calcium channel blocker, a blocker of renin-angiotensin system, and a thiazide diuretic, preferably chlorthalidone. Using the updated BP criteria, the prevalence of RH in the United States is found to be modestly increased by approximately 3-4% among treated population. Meta-analysis of observational studies have demonstrated that pseudo-RH from white coat HTN or medication nonadherence is as much common as the truly RH. Thus, screening for pseudo-resistance in the evaluation of all apparent RH is of utmost importance as diagnosis of white-coat HTN requires no treatment, while medication nonadherence would benefit from identifying and targeting barriers to adherence.

Keywords: Hypertension; Resistant hypertension; White coat hypertension.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure / drug effects*
  • Drug Resistance*
  • Drug Therapy, Combination
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy*
  • Hypertension / epidemiology
  • Hypertension / physiopathology
  • Medication Adherence*
  • Risk Factors
  • White Coat Hypertension / epidemiology
  • White Coat Hypertension / physiopathology

Substances

  • Antihypertensive Agents