Resistant hypertension is defined as blood pressure that remains above goal despite treatment with the optimal dosage of three antihypertensive agents, including a diuretic.
Patient characteristics more likely to be associated with resistant hypertension include:
1. Older age
2. BMI above 30
3. Higher baseline blood pressure
4. Diabetes mellitus
5. Black race.
Excessive consumption of dietary salt and alcohol contributes to resistant hypertension. Many patients with resistant hypertension have secondary hypertension caused by primary aldosteronism or renovascular hypertension, and these conditions should be excluded.
Treatment of resistant hypertension should include appropriate lifestyle modifications, discontinuation of agents that may increase blood pressure such as NSAIDs, and correction of secondary causes of hypertension. Mineralocorticoid receptor antagonists are particularly effective in treating resistant hypertension even in the absence of hyperaldosteronism. The Anglo-Scandinavian Cardiac Outcomes Trial evaluated the efficacy of spironolactone among 1411 participants with an average age of 63 years who received this medication mainly as a fourth-line antihypertensive agent for uncontrolled blood pressure. After 1 year of treatment, blood pressure in these patients decreased by approximately 21.9/9.5 mm Hg.
Ardavan Mashhadian D.O.
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017