Resistant Hypertension : A Clinical Perspective - 24/10/19

Doi : 10.1016/j.ecl.2019.08.010

Fady Hannah-Shmouni, MD, FRCPC ^a,^⁎ , Sriram Gubbi, MD ^b, J. David Spence, MD, FRCPC ^c, Constantine A. Stratakis, MD, D(Med)Sci ^a, Christian A. Koch, MD, PhD ^d
^a Internal Medicine-Endocrinology, Hypertension and Metabolic Genetics, Section on Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 10 Center Drive, MSC 1109, Bethesda, MD 20892, USA
^b Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney diseases, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
^c Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Road, London, ON N6G 2V4, Canada
^d The University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN 38163, USA

^∗Corresponding author.

Résumé

Resistant hypertension is a common clinical entity, defined as suboptimal blood pressure response to multiple therapies after excluding medication nonadherence and secondary forms of hypertension. Patients with resistant hypertension generally share several comorbidities. Resistant hypertension is more common in individuals of African descent. Blood pressure should be optimized using multiple strategies, including lifestyle changes and single-pill combination therapies, with the aim of reducing cardiovascular events while reducing side effects from using antihypertensive therapy. A renin/aldosterone–based diagnostic and treatment approach will help tailor therapy. The use of mineralocorticoid receptor antagonists or amiloride as appropriate is favored.

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Keywords : Hypertension, Resistant hypertension, Primary aldosteronism, Renin, Aldosterone, Liddle syndrome, Amiloride

Plan

Key points

Introduction

Diagnosis of hypertension

Diagnosis of resistant hypertension

Secondary forms of hypertension

Biochemical screening for secondary hypertension

Resistant hypertension in African Americans

Medical management of resistant hypertension

Summary

	Disclosure Statement: F. Hannah-Shmouni is a member of the Endocrine Hypertension Subcommittee of the Canadian Hypertension Guidelines (Hypertension Canada) and has no relevant disclosures to report. C.A. Koch is receiving royalties from Springer for the book “Endocrine Hypertension.” All other authors have no relevant disclosures to report.
	Source of support: This research was supported in part by the Intramural Research Program of Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, protocol 00-CH-0160 (Clinical and Molecular Analysis of ACTH-Independent Steroid Hormone Production in Adrenocortical Tissue).