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Resistant hypertension, with a prevalence of approximately 5% in unselected hypertensive populations but rising to 60% in patients with chronic kidney disease or albumin/creatinine ratio ≥300 mg/g [An, 2022; Verdecchia, 2023], is associated with high rates of morbidity and mortality due to CVD and stroke [Carey, 2020; Doumas, 2020]. Resistant hypertension is defined by the failure of combined drug therapy, such as triple therapy, to control BP [Sorte, 2023; Verdecchia, 2023]. However, it is important to distinguish true resistant hypertension from secondary or apparent-resistant hypertension and its causes [Verdecchia, 2023]. The recent ESH guidelines [Mancia, 2023] define resistant hypertension as SBP ≥130 mmHg or diastolic BP ≥80 mmHg in a patient, despite a 3-drug combination at maximum, recommended and tolerated doses, elevated BP confirmed by ambulatory BP monitoring or home BP, and causes of apparent-resistant hypertension excluded e.g poor adherence, drugs, secondary hypertension [Verdecchia, 2023]. The management of true resistant hypertension combines lifestyle changes, discontinuation of interfering substances, rationalisation of current treatment and the sequential addition of antihypertensive drugs to the existing triple combination [Mancia, 2023]. There is the option for renal denervation in specific cases as an additive or alternative to increasing medication [Verdecchia, 2023; Whelton, 2023]. Due to the significant co-morbidities associated with resistant hypertension, it is also recommended that due to the complexity of the required treatment, patients be referred to specialist centres with recognised expertise in the management of patients with hypertension.
After listening to this podcast, participants will be able to:
Cardiologists, internists, general practitioners, nurse practitioners and other HCPs who manage patients with CVD and hypertension.
English with voice over into Russian and Chinese
Podcast & Infographic
Re-visiting resistant hypertension
Martin Savage is Emeritus Professor of Paediatric Endocrinology at William Harvey Research Institute, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London. He was head of the Paediatric Endocrine Unit at Barts and the London School of Medicine from 1982 to 2007. He has interests in growth disorders, specifically those with abnormalities in the GH-IGF-1 axis and in phenotype-genotype relationships of GH-IGF-1 axis defects, notably GH resistance. He published the first human case of an IGF-1 gene defect in the New England Journal of Medicine in 1996. His other interests are Cushing’s syndrome and growth in chronic inflammatory diseases. He was General Secretary of the European Society for Paediatric Endocrinology (ESPE) from 1997 to 2004. He has lectured in 60 countries and has published 482 original articles, reviews, textbook chapters and books. In 2007, he was awarded the ESPE Andrea Prader Prize for contributions to paediatric endocrinology and in 2018 he received a Visionary Award from the American Human Growth Foundation. In 2022, he received a Research Excellence Award from the Dr Sulaiman Al Habib Medical Journal in Riyadh, and the British Society of Paediatric Endocrinology & Diabetes James M. Tanner Lifetime Achievement Award. He continues to lecture nationally and internationally.
Rosa Maria Bruno (MD, PhD) is specialist in Internal Medicine and Hypertension, head of the Unit of Clinical Pharmacology and Women’s Cardiovascular Health at the Hopital Européen Georges Pompidou and full professor in Pharmacology at Université Paris Cité (Paris, France). Her research is focused on novel approaches for the non-invasive evaluation of vascular ageing in hypertension and other diseases, with a focus on sex and gender differences. She is secretary of the Artery Society and treasurer of the ESC Council of Hypertension.
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