Interní Med. 2018; 20(4): 167-170 | DOI: 10.36290/int.2018.030

Latest developments in the management of resistant hypertension

prof. MUDr. Renata Cífková, CSc.

Centrum kardiovaskulární prevence 1. LF UK a TN, Praha

Hypertension resistant to treatment is currently defined as a situation when the recommended treatment strategy fails to loweroffice blood pressure to values < 140/90 mmHg, and inadequate control of blood pressure is confirmed by ambulatory bloodpressure monitoring or home blood pressure measurement. The recommended treatment strategy should include treatmentwith optimal or best-tolerated doses of three or more drugs that should include a diuretic and, typically, an ACE inhibitor orangiotensin receptor blocker and a calcium-channel blocker. The estimated prevalence using the above definition is likely to be< 10% of treated patients. Pseudoresistant hypertension and secondary causes of hypertension should be excluded. The recommendedtreatment strategy should include treatment with optimal or best-tolerated doses of three or more drugs that shouldinclude a diuretic and, typically, an ACE inhibitor or angiotensin receptor blocker and a calcium-channel blocker. The fourth-linetreatment should include spironolactone (up to 50 mg a day). Fixed combinations are preferred.

Keywords: pseudoresistant hypertension, ACE inhibitors, angiotensin receptor blockers, secondary hypertension, 24h ambulatory
BP monitoring, home BP measurement

Published: October 1, 2018  Show citation