Resistant Hypertension: A Clinical Perspective

Endocrinol Metab Clin North Am. 2019 Dec;48(4):811-828. doi: 10.1016/j.ecl.2019.08.010.

Abstract

Resistant hypertension is a common clinical entity, defined as suboptimal blood pressure response to multiple therapies after excluding medication nonadherence and secondary forms of hypertension. Patients with resistant hypertension generally share several comorbidities. Resistant hypertension is more common in individuals of African descent. Blood pressure should be optimized using multiple strategies, including lifestyle changes and single-pill combination therapies, with the aim of reducing cardiovascular events while reducing side effects from using antihypertensive therapy. A renin/aldosterone-based diagnostic and treatment approach will help tailor therapy. The use of mineralocorticoid receptor antagonists or amiloride as appropriate is favored.

Keywords: Aldosterone; Amiloride; Hypertension; Liddle syndrome; Primary aldosteronism; Renin; Resistant hypertension.

Publication types

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

MeSH terms

  • Aldosterone / metabolism*
  • Humans
  • Hyperaldosteronism* / complications
  • Hyperaldosteronism* / diagnosis
  • Hyperaldosteronism* / metabolism
  • Hypertension* / diagnosis
  • Hypertension* / etiology
  • Hypertension* / metabolism
  • Hypertension* / therapy
  • Liddle Syndrome* / complications
  • Liddle Syndrome* / diagnosis
  • Liddle Syndrome* / metabolism
  • Renin / metabolism*

Substances

  • Aldosterone
  • Renin