Definitions ; Quality statement 6: Referral to a specialist for people with resistant hypertension . Epub 2013 Aug 5.J Hum Hypertens. In studies where pseudo-resistant hypertension cannot be excluded (for example, 24-h ambulatory BP not obtained), the term apparent resistant hypertension has been used to identify 'apparent' lack of control on > or =3 medications. Expanding our understanding of the causes of resistant hypertension and thereby potentially allowing for more effective prevention and/or treatment will be essential to improve the long-term clinical management of this disorder.Resistant hypertension is defined as blood pressure that remains above goal in spite of the concurrent use of 3 antihypertensive agents of different classes. Adherence is also enhanced by more frequent clinic visits and by having patients record home blood pressure measurements.Weight loss, although not specifically evaluated in patients with resistant hypertension, has a clear benefit in terms of reducing blood pressure and often allows for reduction in the number of prescribed medications. If a 24-hour urine is not used to calculate creatinine clearance, renal function can be calculated by any of a number of validated urine-free formulae.

Resistant hypertension is almost always multifactorial in etiology. Presumably, prognosis is impaired as such patients typically present with a long-standing history of poorly controlled hypertension and commonly have associated cardiovascular risk factors such as diabetes, obstructive sleep apnea, left ventricular hypertrophy (LVH), and/or CKD. Cross- sectional studies and hypertension outcome studies suggest, however, that it is not uncommon. Efficacy assessments of specific multidrug regimens are needed to better guide therapy.

In one of the few genetic evaluations of patients with resistant hypertension, investigators in Finland screened 347 patients with resistant hypertension for mutations of the β and γ subunits of the epithelial sodium channel (ENaC).The CYP3A5 enzyme (11β-hydroxysteroid dehydrogenase type 2) plays an important role in the metabolism of cortisol and corticosterone, particularly in the kidney. Background The long‐term prognosis of refractory hypertension (RfHT), defined as failure to control blood pressure (BP) levels despite an antihypertensive treatment with ≥5 medications including a di doi: 10.12659/MSM.920478.Zhao Y, Zhu J, Liang H, Yang S, Zhang Y, Han W, Chen C, Cao N, Aruhan, Liang P, Du X, Huang J, Wang J, Zhang Y, Yang B.Front Pharmacol.

As older age and obesity are 2 of the strongest risk factors for uncontrolled hypertension, the incidence of resistant hypertension will likely … COVID-19 is an emerging, rapidly evolving situation. doi: 10.1093/eurheartj/suaa016. Area of subpopulations drawn to scale with estimated prevalences in percentages. To purchase additional reprints, call 843-216-2533 or e-mail This statement was previously published in the June 2008 issue of Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. 2013 Mar;30(1-2):207-20. doi: 10.3109/07420528.2012.701135. Daytime sleepiness, loud snoring, and witnessed apnea are suspicious for sleep apnea.

Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on January 3, 2008. In a cross-sectional analysis of Chinese adults ingesting ≥30 drinks a week, the risk of having various forms of hypertension increased from 12% to 14%.Several classes of pharmacological agents can increase blood pressure and contribute to treatment resistance (Given their widespread use, nonnarcotic analgesics, including nonsteroidal antiinflammatory agents (NSAIDs), aspirin, and acetaminophen, are probably the most common offending agents in terms of worsening blood pressure control.Although NSAIDs have an overall modest effect on blood pressure levels, in susceptible individuals significant fluid retention, increases in blood pressure, and/or acute kidney disease may occur.

The presence of carotid, abdominal, or femoral bruits increases the possibility that renal artery stenosis exists. eCollection 2019. Enrolling adequate numbers of participants is also a significant research challenge, particularly in regard to assessing efficacy of experimental treatment modalities. Free PMC article Unable to load your delegates due to an error Cuffs adequately sized for use with extremely obese patients are generally not available with ambulatory or home automated monitors. The prognosis of resistant hypertension is unknown, but cardiovascular risk is undoubtedly increased as patients often have a history of long-standing, severe hypertension complicated by multiple other cardiovascular risk factors such as obesity, sleep apnea, diabetes, and chronic kidney disease.

Unauthorized The degree to which cardiovascular risk is reduced with treatment of resistant hypertension is unknown. 2020 Jan 22;10:1548. doi: 10.3389/fphar.2019.01548.

Resistant hypertension, defined as blood pressure (BP) remaining above goal despite the use of > or =3 antihypertensive medications at maximally tolerated doses (one ideally being a diuretic) or BP that requires > or =4 agents to achieve control, has received more attention with increased efforts to improve BP control rates and the emergence of device-based therapies for hypertension. This is particularly true of thiazide diuretics, which significantly improve blood pressure control when used in combination with most if not all other classes of agents.

In this regard, patient preference will be an important consideration.Resistant hypertension as a specific subgroup remains understudied.