Med. praxi. 2020;17(1):31-34
Latest developments in the management of resistant hypertension
- Centrum kardiovaskulární prevence 1. LF UK a TN, Praha
Hypertension resistant to treatment is currently defined as a situation when the recommended treatment strategy fails to lower office blood pressure to values < 140/90 mmHg, and inadequate control of blood pressure is confirmed by ambulatory blood pressure monitoring or home blood pressure measurement. The recommended treatment strategy should include treatment with optimal or best-tolerated doses of three or more drugs that should include a diuretic and, typically, an ACE inhibitor or angiotensin receptor blocker and a calcium-channel blocker. The estimated prevalence using the above definition is likely to be < 10% of treated patients. Pseudoresistant hypertension and secondary causes of hypertension should be excluded. The recommended treatment strategy should include treatment with optimal or best-tolerated doses of three or more drugs that should include a diuretic and, typically, an ACE inhibitor or angiotensin receptor blocker and a calcium-channel blocker. The fourth-line treatment should include spironolactone (up to 50 mg a day). Fixed combinations are preferred.
Keywords: pseudoresistant hypertension, ACE inhibitors, angiotensin receptor blockers, secondary hypertension, 24h ambulatory BP monitoring, home BP measurement.
Received: January 23, 2020; Revised: January 23, 2020; Accepted: January 23, 2020; Prepublished online: January 23, 2020; Published: March 19, 2020 Show citation
