Document Detail


Current options for the treatment of resistant hypertension.
MedLine Citation:
PMID:  19900021     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with resistant hypertension are those who have uncontrolled blood pressure despite use of three or more antihypertensive medications, or those who require four or more medications to achieve control. When evaluating resistant hypertension it is important to rule out pseudoresistant hypertension that may result from factors including poor blood pressure measurement technique and the white coat effect. Potential contributing factors should be identified and reversed if possible, including obesity, excess alcohol intake and use of interfering medications such as NSAIDS, sympathomimetics and oral contraceptives. Modification of lifestyle factors such as weight loss, sodium restriction and physical activity is paramount for treatment success. Secondary causes of hypertension are common in this patient group and, therefore, appropriate screening tests should be carried out as necessary. Pharmacologic therapy is centered on combination therapy of medications from different mechanisms of action, especially diuretics, which are essential in maximizing antihypertensive effects. The role of mineralocorticoid antagonists is expanding, especially in patients with obstructive sleep apnea and obesity where aldosterone excess may be implicated. Finally, when appropriate, specialist referral may facilitate blood pressure reduction and the ability to meet target blood pressure goals.
Authors:
Mustafa I Ahmed; Roberto Pisoni; David A Calhoun
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Expert review of cardiovascular therapy     Volume:  7     ISSN:  1744-8344     ISO Abbreviation:  Expert Rev Cardiovasc Ther     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-10     Completed Date:  2010-02-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101182328     Medline TA:  Expert Rev Cardiovasc Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  1385-93     Citation Subset:  IM    
Affiliation:
Vascular Biology and Hypertension Program, University of Alabama at Birmingham, 1530 3rd Avenue South, Birmingham, AL 35294-2041, USA. mahmed@uab.edu
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MeSH Terms
Descriptor/Qualifier:
Alcohol Drinking / adverse effects
Antihypertensive Agents / therapeutic use*
Diuretics / therapeutic use*
Drug Interactions
Drug Resistance
Drug Therapy, Combination
Humans
Hypertension / drug therapy*,  etiology,  therapy
Life Style
Obesity / complications
Sodium, Dietary / adverse effects
Treatment Failure
Weight Loss
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Diuretics; 0/Sodium, Dietary

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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