Vol 14, No 4 (2007)
Review Article
Published online: 2007-06-11
Evaluation and treatment of resistant hypertension
Cardiol J 2007;14(4):329-339.
Abstract
Hypertension is a major cause and contributor to stroke, heart and kidney disease. Despite the
development of an arsenal of medication to treat hypertension over the past half-century,
adequate treatment continues to be a major problem in the United States. The Third National
Health and Nutrition Examination Survey (NHANES-III) shows that only 29% of hypertensive
patients reach a blood pressure less than 140/90 mm Hg. Resistant hypertension is defined
as a blood pressure greater than 140/90 mm Hg despite a rational combination of three or more
blood pressure medications including a diuretic. The prevalence of true resistant hypertension in
hypertension clinics is only about 11-13%. Higher prevalence rates are evident in populations
with evidence of end-organ disease such as cardiac or renal disease where lower blood pressure
targets have now been established. Ascertaining the possible cause(s) for resistant hypertension
is a challenge to all clinicians, but critical in eventual determination of a therapeutic solution.
The following review will hopefully help guide clinicians in their discernment of causes and
potential treatments for resistant hypertension. The diagnosis and treatment of the more common
secondary causes will be described and treatment options for patients with resistant hypertension
are discussed. Newer options, some still under clinical investigation, will be described
and their future utility will be discussed. (Cardiol J 2007; 14: 329-339)
Keywords: resistant hypertensionetiologytreatment