Document Detail

Clinical approach in treatment of resistant hypertension.
MedLine Citation:
PMID:  21966229     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Resistant hypertension, defined as failure to achieve target blood pressure despite the use of optimal or maximum doses of at least 3 agents, one of which is a diuretic, or requiring 4 or more medications to achieve blood pressure goal, is likely to affect up to 20% of all patients with hypertension. Apparent resistant hypertension may be caused by medication nonadherence, substances that either interfere with antihypertensive mediations or cause blood pressure elevation, and under- or inappropriate medication treatment. Certain patient characteristics are associated with the presence of resistant hypertension and include chronic kidney disease, diabetes, obesity, and presence of end-organ damage (microalbuminuria, retinopathy, left-ventricular hypertrophy). Secondary causes of resistant hypertension are not uncommon and include obstructive sleep apnea, chronic kidney disease, primary aldosteronism, renal artery stenosis, pheochromocytoma, and Cushing's disease. Initial medication management usually includes adding or increasing the dose of a diuretic, which is effective in lowering the blood pressure of a large number of patients with resistant hypertension. Additional management options include maximizing lifestyle modification, combination therapy of antihypertensive agents depending on individual patient characteristics, adding less-commonly used fourth- or fifth-line antihypertensive agents, and referral to a hypertension specialist.
Jennifer Frank; David Sommerfeld
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Publication Detail:
Type:  Journal Article     Date:  2009-07-30
Journal Detail:
Title:  Integrated blood pressure control     Volume:  2     ISSN:  1178-7104     ISO Abbreviation:  Integr Blood Press Control     Publication Date:  2009  
Date Detail:
Created Date:  2011-10-03     Completed Date:  2011-11-10     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101562709     Medline TA:  Integr Blood Press Control     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  9-23     Citation Subset:  -    
University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, Appleton, WI, USA.
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