The Obstinate Refractory and Resistance Hypertension

Raj Kamal Choudhry; Amrendra Kumar Singh

doi:doi:10.11648/j.ajim.20200805.13

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The Obstinate Refractory and Resistance Hypertension

Raj Kamal Choudhry, Amrendra Kumar Singh

Published in American Journal of Internal Medicine (Volume 8, Issue 5)

Received: 17 April 2020 Accepted: 3 August 2020 Published: 20 August 2020

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Abstract

Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed.

Published in	American Journal of Internal Medicine (Volume 8, Issue 5)
DOI	10.11648/j.ajim.20200805.13
Page(s)	211-214
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Aldosterone, Antihypertensive Treatment Failure, Treatment Resistance, Sympathetic Activity, Volume Dependent

References

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APA Style

Raj Kamal Choudhry, Amrendra Kumar Singh. (2020). The Obstinate Refractory and Resistance Hypertension. American Journal of Internal Medicine, 8(5), 211-214. https://doi.org/10.11648/j.ajim.20200805.13

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ACS Style

Raj Kamal Choudhry; Amrendra Kumar Singh. The Obstinate Refractory and Resistance Hypertension. Am. J. Intern. Med. 2020, 8(5), 211-214. doi: 10.11648/j.ajim.20200805.13

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AMA Style

Raj Kamal Choudhry, Amrendra Kumar Singh. The Obstinate Refractory and Resistance Hypertension. Am J Intern Med. 2020;8(5):211-214. doi: 10.11648/j.ajim.20200805.13

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@article{10.11648/j.ajim.20200805.13,
  author = {Raj Kamal Choudhry and Amrendra Kumar Singh},
  title = {The Obstinate Refractory and Resistance Hypertension},
  journal = {American Journal of Internal Medicine},
  volume = {8},
  number = {5},
  pages = {211-214},
  doi = {10.11648/j.ajim.20200805.13},
  url = {https://doi.org/10.11648/j.ajim.20200805.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20200805.13},
  abstract = {Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed.},
 year = {2020}
}

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TY - JOUR
T1 - The Obstinate Refractory and Resistance Hypertension
AU - Raj Kamal Choudhry
AU - Amrendra Kumar Singh
Y1 - 2020/08/20
PY - 2020
N1 - https://doi.org/10.11648/j.ajim.20200805.13
DO - 10.11648/j.ajim.20200805.13
T2 - American Journal of Internal Medicine
JF - American Journal of Internal Medicine
JO - American Journal of Internal Medicine
SP - 211
EP - 214
PB - Science Publishing Group
SN - 2330-4324
UR - https://doi.org/10.11648/j.ajim.20200805.13
AB - Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed.
VL - 8
IS - 5
ER -

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Author Information

Raj Kamal Choudhry

JLN Medical College, Aryabhatta University, Bhagalpur, Bihar, India
Amrendra Kumar Singh

JLN Medical College, Aryabhatta University, Bhagalpur, Bihar, India

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APA Style

Raj Kamal Choudhry, Amrendra Kumar Singh. (2020). The Obstinate Refractory and Resistance Hypertension. American Journal of Internal Medicine, 8(5), 211-214. https://doi.org/10.11648/j.ajim.20200805.13

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ACS Style

Raj Kamal Choudhry; Amrendra Kumar Singh. The Obstinate Refractory and Resistance Hypertension. Am. J. Intern. Med. 2020, 8(5), 211-214. doi: 10.11648/j.ajim.20200805.13

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AMA Style

Raj Kamal Choudhry, Amrendra Kumar Singh. The Obstinate Refractory and Resistance Hypertension. Am J Intern Med. 2020;8(5):211-214. doi: 10.11648/j.ajim.20200805.13

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@article{10.11648/j.ajim.20200805.13,
  author = {Raj Kamal Choudhry and Amrendra Kumar Singh},
  title = {The Obstinate Refractory and Resistance Hypertension},
  journal = {American Journal of Internal Medicine},
  volume = {8},
  number = {5},
  pages = {211-214},
  doi = {10.11648/j.ajim.20200805.13},
  url = {https://doi.org/10.11648/j.ajim.20200805.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20200805.13},
  abstract = {Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed.},
 year = {2020}
}

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