Diagnosis and Management of Resistant Hypertension: A Review - PubMed
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- #hypertension
- #resistant-hypertension
- #cardiovascular-health
- Hypertension affects 43.9% of women and 49.5% of men in the US.
- Approximately 19.7% of treated patients have apparent resistant hypertension (BP ≥130/80 mm Hg despite 3+ medications).
- True resistant hypertension affects 10% of patients after excluding white-coat hypertension, nonadherence, and secondary causes.
- Risk factors include obesity, diabetes, chronic kidney disease, and sleep apnea.
- Resistant hypertension increases cardiovascular death risk (absolute risk increase: 10.3% at 5-10 years).
- Lifestyle modifications: low-sodium diet (<1500 mg/d), reduced alcohol, aerobic exercise (150 min/wk), and weight loss.
- Avoid illicit drugs and medications that increase BP (e.g., NSAIDs, SNRIs).
- Pharmacologic optimization includes combination tablets, intensified diuretic therapy (e.g., chlorthalidone), and evidence-based algorithms.
- Spironolactone (25-50 mg/d) lowers office SBP by -13.3 mm Hg in resistant hypertension patients.
- Renal denervation reduces 24-hour ambulatory SBP by -4.4 mm Hg and office SBP by -6.6 mm Hg.