REFRACTORY HYPERTENSION – MODERN APPROACHES TO DIAGNOSTICS AND TREATMENT
https://doi.org/10.20996/1819-6446-2010-6-2-206-211
Abstract
The refractory arterial hypertension (HT) is diagnosed, if therapy with three antihypertensive drugs from different classes (including a diuretic) in optimal doses did not provide target blood pressure (BP) level. Prevalence of a refractory HT is high and reaches up 10-30% among hypertensive patients. However, poor BP control is often caused by patient non-compliance with the medical recommendations, an inadequate estimation of BP level, and "white coat" HT. It is classified as a pseudo resistance. Obesity, salt and alcohol overconsumption, taking some drugs worsen BP control. Secondary HT causes (sleep apnea syndrome, kidney diseases, renal artery stenosis, and primary hyperaldosteronism) are more possible in patients with refractory HT. Specific treatment of these diseases improves BP control and long-term prognosis. Successful treatment of refractory HT includes detection and correction of reversible risk factors and reasons of the secondary HT, use of the effective combined therapy with the aldosterone antagonist. Improvement of patient compliance is one of key factors of effective treatment.
About the Authors
A. N. Britov
State Research Center for Preventive Medicine of Rosmedtechnology
Russian Federation
Petroverigsky per. 10, Moscow, 101990
Russian Federation
Petroverigsky per. 10, Moscow, 101990
M. M. Bystrova
State Research Center for Preventive Medicine of Rosmedtechnology
Russian Federation
Petroverigsky per. 10, Moscow, 101990
Russian Federation
Petroverigsky per. 10, Moscow, 101990
References
1. Mancia G., De Backer G., Dominiczak A. et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007;28(12):1462-536
2. Calhoun D., Jones D., Textor S. et al. Resistant hypertension: diagnosis, evaluation and treatment.Ascientific statementfrom theAmericanHeartAssociation Professional educational committee ofthe Councilfor high blood pressure research.Hypertension 2008;51(6):1403-19.
3. Garg J.P., Elliott W.J., Folker A. et al. Resistant hypertension revisited: a comparison of two university-based cohorts. Am J Hypertens 2005;18(5 Pt 1):619-26.
4. Cushman W.C., Ford C.E., Cutler J.A. et al. Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering treatment to preventHeart Attack Trial (ALLHAT).J ClinHypertens (Greenwich) 2002;4(6):393-404.
5. Ives N.J., Wheatley K., Stowe R.L. et al. Continuing uncertainty about the value of percutaneous revascularization in atherosclerotic renovascular disease: a meta-analysis of randomized trials. Nephrol Dial Transplant 2003;18(2):298-304.
6. Douma S., Petidis K., Doumas M et al. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet 2008;371(9628):1921-6.
7. Eide I.K., Torjesen P.A., Drolsum A. et al. Low-renin status in therapy-resistant hypertension: a clue to efficient treatment. J Hypertens 2004;22(11):2217-26.
8. Funder J.W., Carey R.M., Fardella C. et al. Case detection, diagnosis and treatment of patients with primary aldosteronism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2008;93(9):3266-81.
9. Omura M., Saito J., Yamaguchi K. et al. Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res 2004;27(3):193-202.
10. Симоненко В.Б. Нейрогормональные опухоли. М., 2003.
11. Appel L.J., Moore T.J., Obarzanek E. et al. A clinical trial of dietary pattern on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997;336(16):1117-24.
12. Hermida R.C., AyalaD.E., Calvo C. et al. Effects oftime ofthe day oftreatment on ambulatory blood pressure pattern of patient with resistant hypertension. Hypertension 2005;46(4):1053-9.
Review
For citations:
Britov A.N., Bystrova M.M. REFRACTORY HYPERTENSION – MODERN APPROACHES TO DIAGNOSTICS AND TREATMENT. Rational Pharmacotherapy in Cardiology. 2010;6(2):206-211. (In Russ.) https://doi.org/10.20996/1819-6446-2010-6-2-206-211
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