| Resistant hypertension in office practice: a clinical approach. | |
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MedLine Citation:
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PMID: 21068532 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Resistant hypertension is defined as blood pressure uncontrolled to guideline levels despite the use of ≥3 antihypertensive medications. When evaluating patients with resistant hypertension, it is important to consider issues such as blood pressure measurement technique, lifestyle, other comorbid conditions and medications, and the white coat effect. To this point, potential contributing factors include obstructive sleep apnea, excess alcohol intake, and use of blood pressure-elevating medications, such as nonsteroidal anti-inflammatory drugs, sympathomimetics, certain anorexic agents, and oral contraceptives. Secondary causes of hypertension are common in patients with resistant hypertension and appropriate screening tests should be performed as suggested by signs, symptoms, and laboratory abnormalities. In this regard, there is increasing evidence that hyperaldosteronism is common in the resistant hypertensive patient group. Pharmacologic therapy in patients with resistant hypertension is centered on drug combinations that have different mechanisms of action, including diuretics, which are essential in maximizing antihypertensive effects. The role of mineralocorticoid receptor antagonists is expanding, especially in patients with the metabolic syndrome, where aldosterone excess is increasingly recognized as an etiology of resistant hypertension. Finally, when appropriate, specialist referral may be necessary to appropriately assess and treat these patients. |
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Authors:
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Fadi Siyam; Stephen A Brietzke; James R Sowers |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Hospital practice (1995) Volume: 38 ISSN: 2154-8331 ISO Abbreviation: Hosp Pract (Minneap) Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-11 Completed Date: 2010-12-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101268948 Medline TA: Hosp Pract (Minneap) Country: United States |
Other Details:
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Languages: eng Pagination: 90-7 Citation Subset: AIM; IM |
Affiliation:
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Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Alcoholism
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complications Algorithms Antihypertensive Agents / therapeutic use Causality Decision Trees Diagnosis, Differential Diuretics / therapeutic use Drug Therapy, Combination Humans Hyperaldosteronism / complications Hypertension / diagnosis*, drug therapy*, etiology Hyperthyroidism / complications Kidney Diseases / complications Life Style Office Visits* Patient Selection Primary Health Care / methods Referral and Consultation Sleep Apnea, Obstructive / complications Treatment Failure |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents; 0/Diuretics |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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