Author:
Chattranukulchai Pairoj,Roubsanthisuk Weranuj,Kunanon Sirisawat,Kotruchin Praew,Satirapoj Bancha,Wongpraparut Nattawut,Sunthornyothin Sarat,Sukonthasarn Apichard
Abstract
AbstractResistant hypertension (RH) includes hypertensive patients with uncontrolled blood pressure (BP) while receiving ≥3 BP-lowering medications or with controlled BP while receiving ≥4 BP-lowering medications. The exact prevalence of RH is challenging to quantify. However, a reasonable estimate of true RH is around 5% of the hypertensive population. Patients with RH have higher cardiovascular risk as compared with hypertensive patients in general. Standardized office BP measurement, confirmation of medical adherence, search for drug- or substance-induced BP elevation, and ambulatory or home BP monitoring are mandatory to exclude pseudoresistance. Appropriate further investigations, guided by clinical data, should be pursued to exclude possible secondary causes of hypertension. The management of RH includes the intensification of lifestyle interventions and the modification of antihypertensive drug regimens. The essential aspects of lifestyle modification include sodium restriction, body weight control, regular exercise, and healthy sleep. Step-by-step adjustment of the BP-lowering drugs based on the available evidence is proposed. The suitable choice of diuretics according to patients’ renal function is presented. Sacubitril/valsartan can be carefully substituted for the prior renin-angiotensin system blockers, especially in those with heart failure with preserved ejection fraction. If BP remains uncontrolled, device therapy such as renal nerve denervation should be considered. Since device-based treatment is an invasive and costly procedure, it should be used only after careful and appropriate case selection. In real-world practice, the management of RH should be individualized depending on each patient’s characteristics.
Publisher
Springer Science and Business Media LLC
Reference51 articles.
1. Aekplakorn W. The Thai National Health Examination Survey V (NHES V), Accessed from http://ww.hrsi.or.th/researcher/research/new-release/detail/7711.
2. Aekplakorn W. The Thai National Health Examination Survey VI (NHES VI), Accessed from http://ww.hrsi.or.th/media/printed-matter/detail/13443.
3. Sakboonyarat B, Rangsin R, Kantiwong A, Mungthin M. Prevalence and associated factors of uncontrolled HT among hypertensive patients: a nationwide survey in Thailand. BMC Res Notes. 2019;12:380.
4. Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al. American Heart Association Professional/Public Education and Publications Committee of the Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Genomic and Precision Medicine; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council. Resistant Hypertension: Detection, Evaluation, and Management: a Scientific Statement From the American Heart Association. Hypertension. 2018; 72: e53–90.
5. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the council for high blood pressure research. Hypertension. 2008;51:1403–19.
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