Resistant arterial hypertension

Abstract

The review provides modern data on the examination and treatment tactics of patients with resistant arterial hypertension (RAH). The prevalence of RAH is about 10–15%, with a significant proportion of pseudo-resistance cases associated with low adherence to therapy, inaccurate blood pressure measurement technique, and increased arterial stiffness in the elderly. In patients with RAH, it is necessary to exclude secondary hypertension, of which drug hypertension associated with the use of nonsteroidal anti-inflammatory drugs, nasal sympathomimetics, oral contraceptives, as well as those caused by obstructive sleep apnea syndrome or primary hyperaldosteronism are prevalent. Secondary hypertension is often asymptomatic, therefore, additional examination is required for patients without the classic signs of these diseases. Pharmacotherapy of RAH includes a high-dose combination of antihypertensive drugs. In the first instance, first-line drugs (the renin-angiotensin system blockers, calcium antagonists, thiazide diuretics) should be combined with mineralocorticoid receptor antagonists, which have a good evidence base (PATHWAY-2, ReHOT studies), and then other reserve drugs. The study of interventional methods for the treatment of RAH continues. To date, the effectiveness of renal denervation has been proven. The study of the method of carotid baroreflex amplification continues. Keywords: arterial hypertension, resistant arterial hypertension, secondary arterial hypertension, antihypertensive therapy, renal denervation For citation: Rodionov AV, Yudin IG, Fomin VV. Resistant arterial hypertension. Consilium Medicum. 2021; 23 (1): 28–31. DOI: 10.26442/20751753.2021.1.200697