Rethinking Resistant Hypertension

Gabrielle Bourque, Swapnil Hiremath, Gabrielle Bourque, Swapnil Hiremath

Abstract

Resistant hypertension is common and known to be a risk factor for cardiovascular events, including stroke, myocardial infarction, heart failure, and cardiovascular mortality, as well as adverse renal events, including chronic kidney disease and end-stage kidney disease. This review will discuss the definition of resistant hypertension as well as the most recent evidence regarding its diagnosis, evaluation, and management. The issue of medication non-adherence and its association with apparent treatment-resistant hypertension will be addressed. Non-pharmacological interventions for the treatment of resistant hypertension will be reviewed. Particular emphasis will be placed on pharmacological interventions, highlighting the role of mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors and device therapy, including renal denervation, baroreceptor activation or modulation, and central arteriovenous fistula creation.

Keywords: adherence; apparent treatment-resistant hypertension; hypertension; mineralocorticoid receptor antagonists; resistant hypertension; review; sodium-glucose cotransporter-2 inhibitors.

Conflict of interest statement

The authors declare that they have no conflict of interest.

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