Cor Vasa 2011, 53(8-9):423-428 | DOI: 10.33678/cor.2011.108

Management of resistant hypertension

Robert Holaj
Centrum pro výzkum, diagnostiku a léčbu arteriální hypertenze, III. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Antihypertensive drugs which are effective to decrease blood pressure below values of 140/90 mmHg in all patients with arterial hypertension are still unknown. This review article summarizes some proved diagnostic and therapeutic procedures used in care for patients with resistant hypertension. Combined antihypertensive treatment including aldosterone receptor blocker spironolactone seems to be promising therapeutic approach. At first, non-compliance and secondary hypertension must be excluded. In case of failure of all pharmacotherapy, non-pharmaceutical approaches, such as implantable devices or renal sympathetic denervation, should be considered.

Keywords: Hypertension; Resistant hypertension; Mineralocorticoid receptor antagonists; Spironolactone; Carotid baroreceptors stimulation; Renal sympathetic denervation

Published: August 1, 2011  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Holaj R. Management of resistant hypertension. Cor Vasa. 2011;53(8-9):423-428. doi: 10.33678/cor.2011.108.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007;25:1105-1187. Go to original source... Go to PubMed...
    2. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981-2997.
    3. Pikus T, Widimský J Jr, Zelinka T, et al. Prevalence a klinická charakteristika rezistentní hypertenze ve specializovaném centru. Cor Vasa 2007;49:351-354. Go to original source...
    4. Cuspidi C, Macca G, Sampieri L, et al. High prevalence of cardiac and extracardiac target organ damage in refractory hypertension. J Hypertens 2001;19:2063-2070. Go to original source... Go to PubMed...
    5. Pierdomenico SD, Lapenna D, Bucci A, et al. Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 2005;18:1422-1428. Go to original source... Go to PubMed...
    6. Rosa J, Štrauch B, Petrák O, et al. Relationship between clinical, 24-hour, average day-time and night-time blood pressure and measures of arterial stiffness in essential hypertension. Physiol Res/Acad Sci Bohemoslov 2008;57:303-306. Go to original source...
    7. Corrao G, Parodi A, Nicotra F, et al. Better compliance to antihypertensive medications reduces cardiovascular risk. J Hypertens 2011;29:610-618. Go to original source... Go to PubMed...
    8. Pimenta E, Calhoun DA. Aldosterone and metabolic dysfunction: an unresolved issue. Hypertension 2009;53:585-586. Go to original source... Go to PubMed...
    9. Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of the trials of hypertension prevention (TOHP). BMJ Clin Res 2007;334:885-888. Go to original source... Go to PubMed...
    10. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001;344:3-10. Go to original source... Go to PubMed...
    11. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008;51:1403-1419. Go to original source... Go to PubMed...
    12. Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009;27:2121-2158. Go to original source... Go to PubMed...
    13. Ernst ME, Carter BL, Goerdt CJ, et al. Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure. Hypertension 2006;47:352-358. Go to original source... Go to PubMed...
    14. Viera AJ, Hinderliter AL. Evaluation and management of the patient with difficult-to-control or resistant hypertension. Am Fam Physician 2009;79:863-869. Go to PubMed...
    15. Lim PO, Jung RT, MacDonald TM. Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow-up study. Br J Clin Pharmacol 1999;48:756-760. Go to original source...
    16. Chapman N, Dobson J, Wilson S, et al. Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension 2007;49:839-845. Go to original source... Go to PubMed...
    17. Nishizaka MK, Zaman MA, Calhoun DA. Efficacy of low-dose spironolactone in subjects with resistant hypertension. Am J Hypertens 2003;16:925-930. Go to original source...
    18. Ouzan J, Perault C, Lincoff AM, et al. The role of spironolactone in the treatment of patients with refractory hypertension. Am J Hypertens 2002; 15:333-339. Go to original source...
    19. de Souza F, Muxfeldt E, Fiszman R, Salles G. Efficacy of spironolactone therapy in patients with true resistant hypertension. Hypertension 2010;55:147-152. Go to original source... Go to PubMed...
    20. Sharabi Y, Adler E, Shamis A, et al. Efficacy of add-on aldosterone receptor blocker in uncontrolled hypertension. Am J Hypertens 2006;19:750-755. Go to original source... Go to PubMed...
    21. Alvarez-Alvarez B, Abad-Cardiel M, Fernandez-Cruz A, Martell-Claros N. Management of resistant arterial hypertension: role of spironolactone versus double blockade of the renin-angiotensin-aldosterone system. J Hypertens 2010;28:2329-2335. Go to original source... Go to PubMed...
    22. Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008;358:1547-1559. Go to original source... Go to PubMed...
    23. Václavík J, Sedlák R, Plachý M, et al. Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT): A randomized, double-blind, placebo-controlled trial. Hypertension 2011;57:1069-1075. Go to original source... Go to PubMed...
    24. Václavík J, Kociánová E, Táborský M. Využití spironolaktonu v léčbě rezistentní arteriální hypertenze. Cor Vasa 2011;53:343-347. Go to original source...
    25. Dluhy RG, Williams GH. Aldosterone - villain or bystander? N Engl J Med 2004;351:8-10. Go to original source... Go to PubMed...
    26. Sartori M, Calo LA, Mascagna V, et al. Aldosterone and refractory hypertension: a prospective cohort study. Am J Hypertens 2006;19:373-379; discussion 380. Go to original source... Go to PubMed...
    27. Eide IK, Torjesen PA, Drolsum A, et al. Low-renin status in therapy-resistant hypertension: a clue to efficient treatment. J Hypertens 2004;22:2217-2226. Go to original source...
    28. Laragh J. Laragh's lessons in pathophysiology and clinical pearls for treating hypertension. Lesson XXIV: on the major roles of the renin system in the pathogenesis of hypertension and of its sequelae, heart attack, heart failure, kidney failure, and stroke: replies to commonly asked questions. Am J Hypertens 2001;14:733-742. Go to original source...
    29. Laragh JH, Sealey JE. Relevance of the plasma renin hormonal control system that regulates blood pressure and sodium balance for correctly treating hypertension and for evaluating ALLHAT. Am J Hypertens 2003;16:407-415. Go to original source...
    30. Staessen J, Lijnen P, Fagard R, et al. Rise in plasma concentration of aldosterone during long-term angiotensin II suppression. J Endocrinol 1981;91:457-465. Go to original source...
    31. Newton-Cheh C, Guo CY, Gona P, et al. Clinical and genetic correlates of aldosterone-to-renin ratio and relations to blood pressure in a community sample. Hypertension 2007;49:846-856. Go to original source... Go to PubMed...
    32. Pratt-Ubunama MN, Nishizaka MK, Calhoun DA. Aldosterone antagonism: an emerging strategy for effective blood pressure lowering. Curr Hypertens Rep 2005;7:186-192. Go to original source...
    33. Ceral J, Solař M. Doxazosin: safety and efficacy in the treatment of resistant arterial hypertension. Blood Press 2009;18:74-77. Go to original source... Go to PubMed...
    34. Weber MA, Black H, Bakris G, et al. A selective endothelin-receptor antagonist to reduce blood pressure in patients with treatment-resistant hypertension: a randomised, double-blind, placebo-controlled trial. Lancet 2009;374:1423-1431. Go to original source... Go to PubMed...
    35. Bisognano JD, Kaufman CL, Bach DS, et al. Improved cardiac structure and function with chronic treatment using an implantable device in resistant hypertension: results from European and United States trials of the Rheos system. J Am Coll Cardiol 2011;57:1787-1788. Go to original source... Go to PubMed...
    36. Krum H, Schlaich M, Whitbourn R, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 2009;373:1275-1281. Go to original source... Go to PubMed...
    37. Esler MD, Krum H, Sobotka PA, et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010;376:1903-1909. Go to original source... Go to PubMed...
    38. Ceral J, Žižka J, Eliáš P, et al. Neurovascular compression in essential hypertension: cause, consequence or unrelated finding? J Hum Hypertens 2007;21:179-181. Go to original source... Go to PubMed...
    39. Frank H, Heusser K, Geiger H, et al. Temporary reduction of blood pressure and sympathetic nerve activity in hypertensive patients after microvascular decompression. Stroke 2009;40:47-51. Go to original source... Go to PubMed...
    40. Patel NK, Javed S, Khan S, et al. Deep brain stimulation relieves refractory hypertension. Neurology 2011;76:405-407. Go to original source... Go to PubMed...

    Return to the content


    Cor et Vasa

    You are accessing a site intended for medical professionals, not the lay public. The site may also contain information that is intended only for persons authorized to prescribe and dispense medicinal products for human use.

    I therefore confirm that I am a healthcare professional under Act 40/1995 Coll. as amended by later regulations and that I have read the definition of a healthcare professional.


    No
    Yes