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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...

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Autores principales: Bădilă, Elisabeta, Japie, Cristina, Weiss, Emma, Balahura, Ana-Maria, Bartoș, Daniela, Scafa Udriște, Alexandru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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