The Global Burden of Resistant Hypertension and Potential Treatment Options
Resistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains ≥140 mmHg or ≥90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This def...
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| Format: | Article |
| Language: | English |
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Radcliffe Medical Media
2024-06-01
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| Series: | European Cardiology Review |
| Online Access: | https://www.ecrjournal.com/articleindex/ecr.2023.51 |
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| author | Giacomo Buso Claudia Agabiti-Rosei Matteo Lemoli Federica Corvini Maria Lorenza Muiesan |
| author_facet | Giacomo Buso Claudia Agabiti-Rosei Matteo Lemoli Federica Corvini Maria Lorenza Muiesan |
| author_sort | Giacomo Buso |
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| description | Resistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains ≥140 mmHg or ≥90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This definition encompasses the category of controlled RH, defined as the presence of blood pressure (BP) effectively controlled by four or more antihypertensive agents, as well as refractory hypertension, referred to as uncontrolled BP despite five or more drugs of different classes, including a diuretic. To confirm RH presence, various causes of pseudo-resistant hypertension (such as improper BP measurement techniques and poor medication adherence) and secondary hypertension must be ruled out. Inadequate BP control should be confirmed by out-of-office BP measurement. RH affects about 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Once RH presence is confirmed, patient evaluation includes identification of contributing factors such as lifestyle issues or interfering drugs/substances and assessment of hypertension-mediated organ damage. Management of RH comprises lifestyle interventions and optimisation of current medication therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled and renal denervation can be considered as an additional treatment option. However, achieving optimal BP control remains challenging in this setting. This review aims to provide an overview of RH, including its epidemiology, pathophysiology, diagnostic work-up, as well as the latest therapeutic developments. |
| format | Article |
| id | doaj-art-dbf557c090fe44bc9ec847615d451d4a |
| institution | OA Journals |
| issn | 1758-3756 1758-3764 |
| language | English |
| publishDate | 2024-06-01 |
| publisher | Radcliffe Medical Media |
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| series | European Cardiology Review |
| spelling | doaj-art-dbf557c090fe44bc9ec847615d451d4a2025-08-20T01:56:38ZengRadcliffe Medical MediaEuropean Cardiology Review1758-37561758-37642024-06-011910.15420/ecr.2023.51The Global Burden of Resistant Hypertension and Potential Treatment OptionsGiacomo Buso0Claudia Agabiti-Rosei1Matteo Lemoli2Federica Corvini3Maria Lorenza Muiesan4Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, Brescia, Italy; Lausanne University Hospital, University of Lausanne, Lausanne, SwitzerlandDepartment of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, Brescia, ItalyResistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains ≥140 mmHg or ≥90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This definition encompasses the category of controlled RH, defined as the presence of blood pressure (BP) effectively controlled by four or more antihypertensive agents, as well as refractory hypertension, referred to as uncontrolled BP despite five or more drugs of different classes, including a diuretic. To confirm RH presence, various causes of pseudo-resistant hypertension (such as improper BP measurement techniques and poor medication adherence) and secondary hypertension must be ruled out. Inadequate BP control should be confirmed by out-of-office BP measurement. RH affects about 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Once RH presence is confirmed, patient evaluation includes identification of contributing factors such as lifestyle issues or interfering drugs/substances and assessment of hypertension-mediated organ damage. Management of RH comprises lifestyle interventions and optimisation of current medication therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled and renal denervation can be considered as an additional treatment option. However, achieving optimal BP control remains challenging in this setting. This review aims to provide an overview of RH, including its epidemiology, pathophysiology, diagnostic work-up, as well as the latest therapeutic developments.https://www.ecrjournal.com/articleindex/ecr.2023.51 |
| spellingShingle | Giacomo Buso Claudia Agabiti-Rosei Matteo Lemoli Federica Corvini Maria Lorenza Muiesan The Global Burden of Resistant Hypertension and Potential Treatment Options European Cardiology Review |
| title | The Global Burden of Resistant Hypertension and Potential Treatment Options |
| title_full | The Global Burden of Resistant Hypertension and Potential Treatment Options |
| title_fullStr | The Global Burden of Resistant Hypertension and Potential Treatment Options |
| title_full_unstemmed | The Global Burden of Resistant Hypertension and Potential Treatment Options |
| title_short | The Global Burden of Resistant Hypertension and Potential Treatment Options |
| title_sort | global burden of resistant hypertension and potential treatment options |
| url | https://www.ecrjournal.com/articleindex/ecr.2023.51 |
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