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Clinical approach in treatment of resistant hypertension

Resistant hypertension, defined as failure to achieve target blood pressure despite the use of optimal or maximum doses of at least 3 agents, one of which is a diuretic, or requiring 4 or more medications to achieve blood pressure goal, is likely to affect up to 20% of all patients with hypertension...

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Detalles Bibliográficos
Autores principales: Frank, Jennifer, Sommerfeld, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180239/
https://www.ncbi.nlm.nih.gov/pubmed/21966229
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author Frank, Jennifer
Sommerfeld, David
author_facet Frank, Jennifer
Sommerfeld, David
author_sort Frank, Jennifer
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description Resistant hypertension, defined as failure to achieve target blood pressure despite the use of optimal or maximum doses of at least 3 agents, one of which is a diuretic, or requiring 4 or more medications to achieve blood pressure goal, is likely to affect up to 20% of all patients with hypertension. Apparent resistant hypertension may be caused by medication nonadherence, substances that either interfere with antihypertensive mediations or cause blood pressure elevation, and under- or inappropriate medication treatment. Certain patient characteristics are associated with the presence of resistant hypertension and include chronic kidney disease, diabetes, obesity, and presence of end-organ damage (microalbuminuria, retinopathy, left-ventricular hypertrophy). Secondary causes of resistant hypertension are not uncommon and include obstructive sleep apnea, chronic kidney disease, primary aldosteronism, renal artery stenosis, pheochromocytoma, and Cushing’s disease. Initial medication management usually includes adding or increasing the dose of a diuretic, which is effective in lowering the blood pressure of a large number of patients with resistant hypertension. Additional management options include maximizing lifestyle modification, combination therapy of antihypertensive agents depending on individual patient characteristics, adding less-commonly used fourth- or fifth-line antihypertensive agents, and referral to a hypertension specialist.
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spelling pubmed-31802392011-09-30 Clinical approach in treatment of resistant hypertension Frank, Jennifer Sommerfeld, David Integr Blood Press Control Review Resistant hypertension, defined as failure to achieve target blood pressure despite the use of optimal or maximum doses of at least 3 agents, one of which is a diuretic, or requiring 4 or more medications to achieve blood pressure goal, is likely to affect up to 20% of all patients with hypertension. Apparent resistant hypertension may be caused by medication nonadherence, substances that either interfere with antihypertensive mediations or cause blood pressure elevation, and under- or inappropriate medication treatment. Certain patient characteristics are associated with the presence of resistant hypertension and include chronic kidney disease, diabetes, obesity, and presence of end-organ damage (microalbuminuria, retinopathy, left-ventricular hypertrophy). Secondary causes of resistant hypertension are not uncommon and include obstructive sleep apnea, chronic kidney disease, primary aldosteronism, renal artery stenosis, pheochromocytoma, and Cushing’s disease. Initial medication management usually includes adding or increasing the dose of a diuretic, which is effective in lowering the blood pressure of a large number of patients with resistant hypertension. Additional management options include maximizing lifestyle modification, combination therapy of antihypertensive agents depending on individual patient characteristics, adding less-commonly used fourth- or fifth-line antihypertensive agents, and referral to a hypertension specialist. Dove Medical Press 2009-07-30 /pmc/articles/PMC3180239/ /pubmed/21966229 Text en © 2009 Frank and Sommerfield, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
spellingShingle Review
Frank, Jennifer
Sommerfeld, David
Clinical approach in treatment of resistant hypertension
title Clinical approach in treatment of resistant hypertension
title_full Clinical approach in treatment of resistant hypertension
title_fullStr Clinical approach in treatment of resistant hypertension
title_full_unstemmed Clinical approach in treatment of resistant hypertension
title_short Clinical approach in treatment of resistant hypertension
title_sort clinical approach in treatment of resistant hypertension
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180239/
https://www.ncbi.nlm.nih.gov/pubmed/21966229
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