Vnitr Lek 2024, 70(2):108-112 | DOI: 10.36290/vnl.2024.022

Resistant hypertension

Jan Filipovský

II. interní klinika LF UK a FN Plzeň

Resistant hypertension is defined as blood pressure (BP) ≥ 140/90 mmHg despite administration of at least three antihypertensive drugs including diuretics in maximum tolerated doses. Pseudoresistance due to bad adherence to treatment is very common. Ambulatory BP monitoring should be done should be performed as up to one third of patients has ambulatory BP within normal limits. Secondary causes of hypertension should be excluded. Resistance on treatment is common in patients with renal parenchymatous hypertension. The diagnosis of primary aldosteronism may be more difficult and may occur also in young patients with hypertension. Other causes include diabetes mellitus with advanced organ complications or advanced general atherosclerosis. Response to treatment may also be suppressed by some drugs. Diuretics are very important in the treatment of resistant hypertension because volume expansion, sometimes inapparent, is common. Chlortalidone and indapamide are preferred. Spironolactone can be added as a fourth drug; in individuals with a risk of hyperkalaemia, betablocker or alphablocker should be used. Denervation of renal sympathicus has not been proved to be more effective than drug therapy.

Keywords: resistant hypertension, pseudoresistance, adherence to treatment, secondary hypertension, response to treatment.

Accepted: March 26, 2024; Published: April 10, 2024  Show citation