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Etiology and Management of Treatment-Resistant Hypertension in African American Adults ≥18 Years: A Literature Review

Treatment-resistant hypertension (TRH) is defined as blood pressure levels that remain above the therapeutic goal despite concurrent use of three or more antihypertensive medications taken at maximally tolerated doses, one of which should be a diuretic. Additionally, individuals on four or more anti...

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Autores principales: Odion-Omonhimin, Lilian O, Marwizi, Farirai M, Chive, Mimidoo, Obasi, Nmachi B, Akinrinmade, Abidemi O, Obitulata-Ugwu, Vivien O, Victor, Folami, Obijiofor, Nkechi B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9595575/
https://www.ncbi.nlm.nih.gov/pubmed/36312638
http://dx.doi.org/10.7759/cureus.29566
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author Odion-Omonhimin, Lilian O
Marwizi, Farirai M
Chive, Mimidoo
Obasi, Nmachi B
Akinrinmade, Abidemi O
Obitulata-Ugwu, Vivien O
Victor, Folami
Obijiofor, Nkechi B
author_facet Odion-Omonhimin, Lilian O
Marwizi, Farirai M
Chive, Mimidoo
Obasi, Nmachi B
Akinrinmade, Abidemi O
Obitulata-Ugwu, Vivien O
Victor, Folami
Obijiofor, Nkechi B
author_sort Odion-Omonhimin, Lilian O
collection PubMed
description Treatment-resistant hypertension (TRH) is defined as blood pressure levels that remain above the therapeutic goal despite concurrent use of three or more antihypertensive medications taken at maximally tolerated doses, one of which should be a diuretic. Additionally, individuals on four or more antihypertensive agents regardless of blood pressure are also considered to have TRH. Amongst people diagnosed with TRH, African American adults face a huge management gap, resulting in increased cardiovascular disease risk. The primary objective of this review was to identify the commonly encountered etiologies and extensively discuss the current management strategies of TRH with a particular focus on African Americans. Relevant studies were identified by analyzing scientific databases and journals such as PubMed, Cochrane, MEDLINE, Cureus, and American Heart Association (AHA). The studies identified and examined common causes of TRH, describing their pathophysiology and highlighting different treatment options for the respective etiologies. The most prevalent etiologies of TRH amongst African Americans were chronic kidney disease (CKD), renal artery stenosis (RAS), fibromuscular dysplasia, obstructive sleep apnea (OSA), endocrine causes (Conn syndrome, Cushing syndrome, etc.), sympathetic nervous system overactivity, lifestyle factors, inaccurate blood pressure measurement, and inappropriate treatment. Of the etiologies reviewed, OSA, lifestyle factors, and CKD exhibited a striking prevalence among the subpopulation studied. Unfortunately, there was a paucity of articles addressing this topic amongst African Americans, and therefore there was not a substantial appreciation of the prevalence of some of the identified etiologies in the population of interest. Thorough diagnostic testing for associated or underlying conditions provides a basis for successful management. This review brought to the fore the need for doctors and patients to collaborate in order to improve TRH management and help patients lead healthier lives.
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spelling pubmed-95955752022-10-28 Etiology and Management of Treatment-Resistant Hypertension in African American Adults ≥18 Years: A Literature Review Odion-Omonhimin, Lilian O Marwizi, Farirai M Chive, Mimidoo Obasi, Nmachi B Akinrinmade, Abidemi O Obitulata-Ugwu, Vivien O Victor, Folami Obijiofor, Nkechi B Cureus Cardiology Treatment-resistant hypertension (TRH) is defined as blood pressure levels that remain above the therapeutic goal despite concurrent use of three or more antihypertensive medications taken at maximally tolerated doses, one of which should be a diuretic. Additionally, individuals on four or more antihypertensive agents regardless of blood pressure are also considered to have TRH. Amongst people diagnosed with TRH, African American adults face a huge management gap, resulting in increased cardiovascular disease risk. The primary objective of this review was to identify the commonly encountered etiologies and extensively discuss the current management strategies of TRH with a particular focus on African Americans. Relevant studies were identified by analyzing scientific databases and journals such as PubMed, Cochrane, MEDLINE, Cureus, and American Heart Association (AHA). The studies identified and examined common causes of TRH, describing their pathophysiology and highlighting different treatment options for the respective etiologies. The most prevalent etiologies of TRH amongst African Americans were chronic kidney disease (CKD), renal artery stenosis (RAS), fibromuscular dysplasia, obstructive sleep apnea (OSA), endocrine causes (Conn syndrome, Cushing syndrome, etc.), sympathetic nervous system overactivity, lifestyle factors, inaccurate blood pressure measurement, and inappropriate treatment. Of the etiologies reviewed, OSA, lifestyle factors, and CKD exhibited a striking prevalence among the subpopulation studied. Unfortunately, there was a paucity of articles addressing this topic amongst African Americans, and therefore there was not a substantial appreciation of the prevalence of some of the identified etiologies in the population of interest. Thorough diagnostic testing for associated or underlying conditions provides a basis for successful management. This review brought to the fore the need for doctors and patients to collaborate in order to improve TRH management and help patients lead healthier lives. Cureus 2022-09-25 /pmc/articles/PMC9595575/ /pubmed/36312638 http://dx.doi.org/10.7759/cureus.29566 Text en Copyright © 2022, Odion-Omonhimin et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Odion-Omonhimin, Lilian O
Marwizi, Farirai M
Chive, Mimidoo
Obasi, Nmachi B
Akinrinmade, Abidemi O
Obitulata-Ugwu, Vivien O
Victor, Folami
Obijiofor, Nkechi B
Etiology and Management of Treatment-Resistant Hypertension in African American Adults ≥18 Years: A Literature Review
title Etiology and Management of Treatment-Resistant Hypertension in African American Adults ≥18 Years: A Literature Review
title_full Etiology and Management of Treatment-Resistant Hypertension in African American Adults ≥18 Years: A Literature Review
title_fullStr Etiology and Management of Treatment-Resistant Hypertension in African American Adults ≥18 Years: A Literature Review
title_full_unstemmed Etiology and Management of Treatment-Resistant Hypertension in African American Adults ≥18 Years: A Literature Review
title_short Etiology and Management of Treatment-Resistant Hypertension in African American Adults ≥18 Years: A Literature Review
title_sort etiology and management of treatment-resistant hypertension in african american adults ≥18 years: a literature review
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9595575/
https://www.ncbi.nlm.nih.gov/pubmed/36312638
http://dx.doi.org/10.7759/cureus.29566
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