Summary
Resistant hypertension defined as requiring 3 or more complementary antihypertensive
drugs at maximally tolerated doses accounts for approximately 3% to 4% of all cases
of hypertension. Its increased incidence over the past decade is related to the increase
in obesity in the Western world. There are a number of dietary factors that affect
sympathetic tone including sodium intake apart from increased body mass. This article
discusses the mechanisms of sympathetic stimulation and activation in the context
of animal models and human studies. In addition, there is a review of clinical trials
with and without device therapy that summarizes the clinical findings. Effective management
should be based on pathophysiologic principles and a focus on blood pressure reduction
to levels well below 150/90 mm Hg because outcome trial evidence and Food and Drug
Administration guidance supports this construct. The key to success of device-based
therapy depends on identifying the cohort with true resistant hypertension that can
benefit from therapies that are adjuncts to pharmacotherapy. Physicians need to concentrate
on educating the patient on lifestyle modifications and themselves on use of proper
combinations of antihypertensive medications. If this approach fails to result in
a safe level of blood pressure then the patient should be referred to a board-certified
clinical hypertension specialist.
Keywords
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Article info
Footnotes
☆Financial support: Dr. Bakris has served as the Principal Investigator for the Simplicity-3 study by Medtronic, and has served as a consultant for Daichi-Sankyo, Novartis, Abbott, Takeda, and Lilly.
☆☆Conflict of interest statement: none.
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Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
