Resistant Hypertension

Hypertension (HTN) is the most common cardiovascular disease and remains a major risk factor for coronary heart disease, cerebrovascular disease, heart failure and renal failure. Fewer than half of patients with HTN in the United States reach their Blood Pressure (BP) goals despite availability of numerous inexpensive generic Antihypertensive Drugs (AHDs) . Approximately 5-10% (up to 20-30%) of patientswith inadequately-controlled HTN have resistant HTN, defined as BP that remains above goal despite optimal doses of 3 AHDs including a diuretic. Resistant HTN includes patients whose BP is controlled on ≥ 4 AHDs but excludes patients whose BP is uncontrolled on a suboptimal AHD regimen or <3 AHDs.

Recent studies suggest that the prevalence of resistant HTN may be increasing over time. Predictors of inadequately-controlled BP that characterize resistant HTN patients include older age, obesity, higher systolic BP, diabetes, Left Ventricular Hypertrophy (LVH), and Chronic Kidney Disease (CKD). Patients with resistant HTN are at elevated risk for adverse cardiovascular outcomes, particularly stroke and hospitalization for heart failure. In this review, we discuss the evaluation and medical management of resistant HTN and describe investigational device-based techniques for management of resistant HTN. Read more...................