Multifactorial management advised for resistant hypertension
It is important to optimally manage lifestyle factors, such as weight, dietary sodium, alcohol, and physical inactivity, and management should also include long-acting thiazide-like diuretics and addition of a mineralocorticoid receptor antagonist, the statement said.
Resistant hypertension should be managed with optimized lifestyle interventions as well as with additional drug therapy, an updated scientific statement from the American Heart Association said.
The statement, which updates recommendations from 2008, defines resistant hypertension as blood pressure that remains elevated above goal despite concurrent use of three antihypertensive drug classes administered at maximum or maximally tolerated doses daily. In addition, the statement noted that patients who reach blood pressure targets on four or more antihypertensive medications can also be considered to have resistant hypertension. Before resistant hypertension is diagnosed, clinicians should ensure that patients are adhering to antihypertensive medications and that a “white-coat effect” is not present, the statement said.
To evaluate patients with resistant hypertension, the statement recommends identifying contributing lifestyle issues and other drugs that could be interfering with the effectiveness of antihypertensive medications, as well as screening for secondary hypertension in a directed manner and assessing target organ damage. For management of resistant hypertension, it is important to optimally manage lifestyle factors, such as weight, dietary sodium, alcohol, and physical inactivity, the statement said.
Management should also include long-acting thiazide-like diuretics, such as chlorthalidone or indapamide, and addition of a mineralocorticoid receptor antagonist, such as spironolactone or eplerenone, the statement said. If blood pressure remains elevated despite these measures, the statement recommends stepwise addition of antihypertensive drugs that have complementary mechanisms of action. Patients whose blood pressure remains uncontrolled should be referred to a hypertension specialist, the statement advised.
The statement also covers drug-related resistant hypertension, sleep disorders and pseudopheochromocytoma, and secondary hypertension and includes an algorithm for management of resistant hypertension. It was published by Hypertension on Sept. 13 and is available free of charge online.