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The Road to Better Management in Resistant Hypertension—Diagnostic and Therapeutic Insights
Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to l...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8153016/ https://www.ncbi.nlm.nih.gov/pubmed/34068168 http://dx.doi.org/10.3390/pharmaceutics13050714 |
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author | Bădilă, Elisabeta Japie, Cristina Weiss, Emma Balahura, Ana-Maria Bartoș, Daniela Scafa Udriște, Alexandru |
author_facet | Bădilă, Elisabeta Japie, Cristina Weiss, Emma Balahura, Ana-Maria Bartoș, Daniela Scafa Udriște, Alexandru |
author_sort | Bădilă, Elisabeta |
collection | PubMed |
description | Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to lower blood pressure below 140/90 mmHg despite adequate lifestyle measures and optimal treatment with at least three medications, including a diuretic, and usually a blocker of the renin-angiotensin system and a calcium channel blocker, at maximally tolerated doses. Hereby, we discuss the diagnostic and therapeutic approach to a better management of R-HTN. Excluding pseudoresistance, secondary hypertension, white-coat hypertension and medication non-adherence is an important step when diagnosing R-HTN. Most recently different phenotypes associated to R-HTN have been described, specifically refractory and controlled R-HTN and masked uncontrolled hypertension. Optimizing the three-drug regimen, including the diuretic treatment, adding a mineralocorticoid receptor antagonist as the fourth drug, a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when failing to achieve target blood pressure values are current recommendations regarding the correct management of R-HTN. |
format | Online Article Text |
id | pubmed-8153016 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-81530162021-05-27 The Road to Better Management in Resistant Hypertension—Diagnostic and Therapeutic Insights Bădilă, Elisabeta Japie, Cristina Weiss, Emma Balahura, Ana-Maria Bartoș, Daniela Scafa Udriște, Alexandru Pharmaceutics Review Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to lower blood pressure below 140/90 mmHg despite adequate lifestyle measures and optimal treatment with at least three medications, including a diuretic, and usually a blocker of the renin-angiotensin system and a calcium channel blocker, at maximally tolerated doses. Hereby, we discuss the diagnostic and therapeutic approach to a better management of R-HTN. Excluding pseudoresistance, secondary hypertension, white-coat hypertension and medication non-adherence is an important step when diagnosing R-HTN. Most recently different phenotypes associated to R-HTN have been described, specifically refractory and controlled R-HTN and masked uncontrolled hypertension. Optimizing the three-drug regimen, including the diuretic treatment, adding a mineralocorticoid receptor antagonist as the fourth drug, a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when failing to achieve target blood pressure values are current recommendations regarding the correct management of R-HTN. MDPI 2021-05-13 /pmc/articles/PMC8153016/ /pubmed/34068168 http://dx.doi.org/10.3390/pharmaceutics13050714 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Bădilă, Elisabeta Japie, Cristina Weiss, Emma Balahura, Ana-Maria Bartoș, Daniela Scafa Udriște, Alexandru The Road to Better Management in Resistant Hypertension—Diagnostic and Therapeutic Insights |
title | The Road to Better Management in Resistant Hypertension—Diagnostic and Therapeutic Insights |
title_full | The Road to Better Management in Resistant Hypertension—Diagnostic and Therapeutic Insights |
title_fullStr | The Road to Better Management in Resistant Hypertension—Diagnostic and Therapeutic Insights |
title_full_unstemmed | The Road to Better Management in Resistant Hypertension—Diagnostic and Therapeutic Insights |
title_short | The Road to Better Management in Resistant Hypertension—Diagnostic and Therapeutic Insights |
title_sort | road to better management in resistant hypertension—diagnostic and therapeutic insights |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8153016/ https://www.ncbi.nlm.nih.gov/pubmed/34068168 http://dx.doi.org/10.3390/pharmaceutics13050714 |
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