Management of Resistant Hypertension

Annu Rev Med. 2024 Jan 29:75:443-457. doi: 10.1146/annurev-med-050922-052605. Epub 2023 Sep 22.

Abstract

Resistant hypertension (RH) is a severe form of hypertension associated with increased cardiovascular risk. Although true RH affects less than 10% of the patients receiving antihypertensive therapy, the absolute number is high and continues to increase. The workup of these patients requires screening for secondary hypertension and pseudoresistance, including poor adherence to prescribed medicines and the white-coat phenomenon. The treatment of RH consists of lifestyle modifications and pharmacological therapies. Lifestyle modifications include dietary adjustments, weight loss, physical activity, and limiting alcohol consumption; pharmacological therapies include diuretics, mineralocorticoid receptor antagonists, beta blockers, angiotensin receptor-neprilysin inhibitors, and others. Over the last 15 years, interventional approaches have emerged as adjunct treatment options; we highlight catheter-based renal denervation. This review summarizes the rationales and latest clinical evidence and, based thereon, proposes an updated algorithm for the management of RH.

Keywords: adherence; device-based therapies; emerging drugs; renal denervation.

Publication types

  • Review

MeSH terms

  • Antihypertensive Agents* / therapeutic use
  • Humans
  • Hypertension* / drug therapy
  • Life Style

Substances

  • Antihypertensive Agents