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.

David A. Calhoun, Daniel Jones, Stephen Textor, David C. Goff, Timothy P. Murphy, Robert D. Toto, Anthony White, William C. Cushman, William White, Domenic Sica, Keith Ferdinand, Thomas D. Giles, Bonita Falkner, Robert M. Carey, Heart Association Professional Education Committee American Heart Association Professional Education Committee

Research output: Contribution to journalArticle

902 Citations (Scopus)

Abstract

Resistant hypertension is a common clinical problem faced by both primary care clinicians and specialists. While the exact prevalence of resistant hypertension is unknown, clinical trials suggest that it is not rare, involving perhaps 20% to 30% of study participants. As older age and obesity are 2 of the strongest risk factors for uncontrolled hypertension, the incidence of resistant hypertension will likely increase as the population becomes more elderly and heavier. The prognosis of resistant hypertension is unknown, but cardiovascular risk is undoubtedly increased as patients often have a history of long-standing, severe hypertension complicated by multiple other cardiovascular risk factors such as obesity, sleep apnea, diabetes, and chronic kidney disease. The diagnosis of resistant hypertension requires use of good blood pressure technique to confirm persistently elevated blood pressure levels. Pseudoresistance, including lack of blood pressure control secondary to poor medication adherence or white coat hypertension, must be excluded. Resistant hypertension is almost always multifactorial in etiology. Successful treatment requires identification and reversal of lifestyle factors contributing to treatment resistance; diagnosis and appropriate treatment of secondary causes of hypertension; and use of effective multidrug regimens. As a subgroup, patients with resistant hypertension have not been widely studied. Observational assessments have allowed for identification of demographic and lifestyle characteristics associated with resistant hypertension, and the role of secondary causes of hypertension in promoting treatment resistance is well documented; however, identification of broader mechanisms of treatment resistance is lacking. In particular, attempts to elucidate potential genetic causes of resistant hypertension have been limited. Recommendations for the pharmacological treatment of resistant hypertension remain largely empiric due to the lack of systematic assessments of 3 or 4 drug combinations. Studies of resistant hypertension are limited by the high cardiovascular risk of patients within this subgroup, which generally precludes safe withdrawal of medications; the presence of multiple disease processes (eg, sleep apnea, diabetes, chronic kidney disease, atherosclerotic disease) and their associated medical therapies, which confound interpretation of study results; and the difficulty in enrolling large numbers of study participants. Expanding our understanding of the causes of resistant hypertension and thereby potentially allowing for more effective prevention and/or treatment will be essential to improve the long-term clinical management of this disorder.

Original languageEnglish (US)
JournalCirculation
Volume117
Issue number25
StatePublished - Jun 24 2008

Fingerprint

Professional Education
Hypertension
Research
Therapeutics
Sleep Apnea Syndromes
Blood Pressure
Chronic Renal Insufficiency
Life Style
Obesity
White Coat Hypertension
Medication Adherence
Drug Combinations

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Calhoun, D. A., Jones, D., Textor, S., Goff, D. C., Murphy, T. P., Toto, R. D., ... American Heart Association Professional Education Committee, H. A. P. E. C. (2008). 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. Circulation, 117(25).

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. / Calhoun, David A.; Jones, Daniel; Textor, Stephen; Goff, David C.; Murphy, Timothy P.; Toto, Robert D.; White, Anthony; Cushman, William C.; White, William; Sica, Domenic; Ferdinand, Keith; Giles, Thomas D.; Falkner, Bonita; Carey, Robert M.; American Heart Association Professional Education Committee, Heart Association Professional Education Committee.

In: Circulation, Vol. 117, No. 25, 24.06.2008.

Research output: Contribution to journalArticle

Calhoun, DA, Jones, D, Textor, S, Goff, DC, Murphy, TP, Toto, RD, White, A, Cushman, WC, White, W, Sica, D, Ferdinand, K, Giles, TD, Falkner, B, Carey, RM & American Heart Association Professional Education Committee, HAPEC 2008, '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.', Circulation, vol. 117, no. 25.
Calhoun, David A. ; Jones, Daniel ; Textor, Stephen ; Goff, David C. ; Murphy, Timothy P. ; Toto, Robert D. ; White, Anthony ; Cushman, William C. ; White, William ; Sica, Domenic ; Ferdinand, Keith ; Giles, Thomas D. ; Falkner, Bonita ; Carey, Robert M. ; American Heart Association Professional Education Committee, Heart Association Professional Education Committee. / 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. In: Circulation. 2008 ; Vol. 117, No. 25.
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