An Update on Refractory Hypertension.

Abstract

PURPOSE OF REVIEW:

To update on definition, diagnosis, prevalence, patient characteristics, pathophysiology, and treatment of refractory hypertension (RfHTN).

RECENT FINDINGS:

Refractory hypertension (RfHTN) is defined as blood pressure (BP) that is uncontrolled despite using ≥ 5 antihypertensive medications of different classes, including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist (MRA) at maximal or maximally tolerated doses. This new phenotype is different from resistant hypertension (RHTN), defined as BP that is uncontrolled despite using ≥ 3 medications, commonly a long-acting calcium channel blocker (CCB), a blocker of the renin-angiotensin system (angiotensin-converting enzyme [ACE] inhibitor or angiotensin receptor blocker [ARB]), and a diuretic. The RHTN phenotype includes controlled RHTN, BP that is controlled on 4 or more medications. RfHTN is largely attributable to increased sympathetic activity, unlike RHTN, which is mainly due to increased intravascular fluid volume frequently caused by hyperaldosteronism and chronic excessive sodium ingestion. Compared to those with controlled RHTN, patients with RfHTN have a higher prevalence of target organ damage and do not have elevated aldosterone levels. Ongoing clinical trials are assessing the safety and efficacy of using devices to aid with BP control in patients with RfHTN. RfHTN is a separate entity from RHTN and is generally attributable to increased sympathetic activity.

• Authors: Faris Matanes, M Bilal Khan, Mohammed Siddiqui, Tanja Dudenbostel, David Calhoun, Suzanne Oparil
• Journal: Current hypertension reports (Curr Hypertens Rep) Vol. 24 Issue 7 Pg. 225-234 (07 2022) ISSN: 1534-3111 [Electronic] United States
• PMID: 35384577 (Publication Type: Journal Article, Review, Research Support, N.I.H., Extramural)
• Copyright: © 2022. The Author(s).

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Antihypertensive Agents

Topics

• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (pharmacology, therapeutic use)
• Antihypertensive Agents (pharmacology, therapeutic use)
• Blood Pressure (physiology)
• Humans
• Hypertension