Management Of Resistant Hypertension An Advance Approach...

Management of Resistant Hypertension: An advance approach with new vision Sandeep Banga MD, Jeffrey Heslop, MD, Dr. Sparrow MD, Sudhir Mungee MD, FACC, FSCAI Definition Resistant hypertension is defined as blood pressure measurement that exceeds 140/90 mmHg (130/80 in patients diagnosed with Diabetes Mellitus/renal insufficiency) despite regular use of three or more antihypertensive drugs of different classes that should include one diuretic at maximum(or maximum tolerated) dose unchanged for at least one month without interruption. {1} Renal insufficiency is defined as creatinine levels above 1.5mg % or protienuria of more than 300mg in 24 hours. Prevalence and Prognosis The reliable estimates of prevalence of resistant hypertension†¦show more content†¦Renovascular Disease c. Cons Syndrome d. Obstructive Sleep Apnea e. Pheochromocytoma f. Thyroid Diseases g. Cushing Syndrome h. Coarctation of Aorta i. Intracranial tumors Pseudo-Resistant Hypertension This term refers to lack of control of blood pressure with appropriate treatment in a patient who does not have resistant hypertension. The following factors may result in this situations{12-16} as given in table below- Causes of Pseudo-Resistant Hypertension 1. Blood pressure measurement not done by proper guidelines. 2. White-Coat Hypertension. 3. Calcified or atherosclerotic arteries as seen in elderly. 4. Poor patient adherence to medications. 5. Inadequate dosing or inappropriate combinations of anti-hypertensives. 6. Physicians’ inertia to increase dose/number of drugs even if targets are not reached. Step Approach by Physician for evaluation and management of Resistant Hypertension. 1. Knowledge and adherence of hypertension treatment according to latest guidelines 2. Identify and reverse the causes of pseudo-resistance 3. Identify and reverse the causes of true-resistance a. know pharmacological agents like NSAIDS which increase BP and discontinue or minimize its use . b. Evaluate amount of alcohol intake and try to cease its use. c. Decrease salt intake to less than 2-3 grams per