scholarly journals Controlling resistant hypertension

2018 ◽  
Vol 3 (2) ◽  
pp. 69-75 ◽  
Author(s):  
J David Spence
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Renal Hypertension ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Aldosterone Antagonists ◽  
Improve Blood Pressure Control ◽  
Blood Pressures

Resistant hypertension (failure to achieve target blood pressures with three or more antihypertensive drugs including a diuretic) is an important and preventable cause of stroke. Hypertension is highly prevalent in China (>60% of persons above age 65), and only ~6% of hypertensives in China are controlled to target levels. Most strokes occur among persons with resistant hypertension; approximately half of strokes could be prevented by blood pressure control. Reasons for uncontrolled hypertension include (1) non-compliance; (2) consumption of substances that aggravated hypertension, such as excess salt, alcohol, licorice, decongestants and oral contraceptives; (3) therapeutic inertia (failure to intensify therapy when target blood pressures are not achieved); and (4) diagnostic inertia (failure to investigate the cause of resistant hypertension). In China, an additional factor is lack of availability of appropriate antihypertensive therapy in many healthcare settings. Sodium restriction in combination with a diet similar to the Cretan Mediterranean or the DASH (Dietary Approaches to Stop Hypertension) diet can lower blood pressure in proportion to the severity of hypertension. Physiologically individualised therapy for hypertension based on phenotyping by plasma renin activity and aldosterone can markedly improve blood pressure control. Renal hypertension (high renin/high aldosterone) is best treated with angiotensin receptor antagonists; primary aldosteronism (low renin/high aldosterone) is best treated with aldosterone antagonists (spironolactone or eplerenone); and hypertension due to overactivity of the renal epithelial sodium channel (low renin/low aldosterone; Liddle phenotype) is best treated with amiloride. The latter is far more common than most physicians suppose.

scholarly journals Guest Editorial: Challenges in Resistant Hypertension

2016 ◽  
Vol 11 (1) ◽  
pp. 18
Author(s):  
Thomas Kahan ◽  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Resistant Hypertension ◽  
Blood Pressure Monitoring ◽  
Premature Death ◽  
Pressure Control ◽  
Secondary Hypertension ◽  
Uncontrolled Hypertension ◽  
Caregiver Support ◽  
The Individual

Hypertension is the major risk factor for disease and premature death. Although the efficacy of antihypertensive therapy is undisputed, few patients reach target blood pressure. Steps to improve treatment and control include assessment of global cardiovascular risk for the individual patient, improving caregiver support, education and organisation, increasing treatment persistence, using out of office blood pressure monitoring more often, detecting secondary hypertension forms, and referring patients with remaining uncontrolled hypertension to a specialist hypertension centre. In conclusion, there is room for improvement of blood pressure control in hypertensive patients. The clinical benefit of improved blood pressure control may be considerable. This may be particularly true for patients with resistant hypertension.

scholarly journals Hemodynamic monitoring using thoracic bioimpedance – an optimal solution for the treatment of hypertension

2018 ◽  
Vol 91 (4) ◽  
pp. 474-478
Author(s):  
Anca Daniela Farcas ◽  
Florin Petru Anton ◽  
Mihaela Mocan ◽  
Luminita Animarie Vida-Simiti
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Hemodynamic Monitoring ◽  
Antihypertensive Drugs ◽  
Optimal Solution ◽  
Pressure Control ◽  
Left Ventricular ◽  
Uncontrolled Hypertension ◽  
Tailored Therapy ◽  
Electrical Bioimpedance

Hypertension is a major issue of public health because of its increasing prevalence and multiple complications caused by failing to achieve an efficient blood pressure control. Considering hypertension as a hemodynamic disorder allows to prescribe a tailored therapy guided by individual hemodynamic parameters, therefore leading to an increased rate of control. We present the case of a 59 years old diabetic, dyslipidemic and obese male who, although treated with 5 classes of antihypertensive drugs had uncontrolled hypertension that caused left ventricular failure. Using the HOTMAN system of hemodynamic monitoring using thoracic electrical bioimpedance allowed a quick identification of the cause and guided the therapy, achieving blood pressure control after 5 days of treatment. Treating hypertension by identifying the underlying hemodynamic imbalance allows prescribing a tailored therapy and shortens the initiation and stabilization phases of treatment.

The single-pill combination or hybrid therapy in prevention of cardiovascular risk. Case reports

2021 ◽  
Vol 14 (1) ◽  
pp. 118-123
Author(s):  
Celina Wojciechowska
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Antihypertensive Drugs ◽  
Case Reports ◽  
Pressure Control ◽  
Cholesterol Concentration ◽  
Therapeutic Goals ◽  
Improve Blood Pressure Control ◽  
Single Pill ◽  
Different Doses

In polish population many patients with comorbid hypertension and hypercholesterolemia present low compliance and adherence to medical advising. The achievement of therapeutic goals of blood pressure control and hypercholesterolemia control was about 5,4% in WOBASZ II study. The therapy with antihypertensive drugs and statin in a single-pill combination (SPC) has recently been strengthened in the European and Polish guidelines for the treatment of arterial hypertension and hypercholesterolemia. It seems that therapy induction with SPC by reducing the number of pills to be taken daily could contribute to solve the problem of not undertaking or discontinuing treatment. The combination product present in different doses give possibility of optimization treatment. The use SCP on a larger scale could improve blood pressure control and cholesterol concentration reduction and prevent many of cardiovascular events.

scholarly journals Extreme Elevations in Blood Pressure and All-Cause Mortality in a Referred CKD Population: Results from the CRISIS Study

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
James Ritchie ◽  
Francesco Rainone ◽  
Darren Green ◽  
Helen Alderson ◽  
Diana Chiu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Mortality Risk ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Blood Pressure Target ◽  
Renal Nerve ◽  
Renal Nerve Ablation ◽  
Pressure Lowering ◽  
Blood Pressures

Hypertension frequently complicates chronic kidney disease (CKD), with studies showing clinical benefit from blood pressure lowering. Subgroups of patients with severe hypertension exist. We aimed to identify patients with the greatest mortality risk from uncontrolled hypertension to define the prevalence and phenotype of patients who might benefit from adjunctive therapies. 1691 all-cause CKD patients from the CRISIS study were grouped by baseline blood pressure—target (<140/80 mmHg); elevated (140–190/80–100 mmHg); extreme (>190 and/or 100 mmHg). Groups were well matched for age, eGFR, and comorbidities. 77 patients had extreme hypertension at recruitment but no increased mortality risk (HR 0.9,P=0.9) over a median follow-up period of 4.5 years. The 1.2% of patients with extreme hypertension at recruitment and at 12-months had a significantly increased mortality risk (HR 4.3,P=0.01). This association was not seen in patients with baseline extreme hypertension and improved 12-month blood pressures (HR 0.86,P=0.5). Most CKD patients with extreme hypertension respond to pharmacological blood pressure control, reducing their risk for death. Patients with extreme hypertension in whom blood pressure control cannot be achieved have an approximate prevalence of 1%. These patients have an increased mortality risk and may be an appropriate group to consider for further therapies, including renal nerve ablation.

scholarly journals Novel approaches to treat resistant hypertension

2020 ◽  
Vol 26 (1) ◽  
pp. 10-34
Author(s):  
Aleksandra Cherneva ◽  
Ivo Petrov
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Current Knowledge ◽  
Pressure Control ◽  
Uncontrolled Hypertension ◽  
Renal Sympathetic Denervation ◽  
Significant Group ◽  
Arterial Blood ◽  
Optimal Blood Pressure

Treatment-resistant hypertension, or resistant hypertension (RH), is defined as arterial hypertension (AH) despite treatment with three properly dosed antihypertensive drugs, at least one of which is a diuretic. Resistant hypertension is associated with an increased incidence of adverse cardiovascular events, renal impairment, and increased mortality. The main treatment of patients with RH is based on maximizing doses of antihypertensive drugs from different groups and adding drugs with complementary mechanisms of action. Despite the combination treatment involving multiple antihypertensive drugs, a small but significant group of patients remains with uncontrolled hypertension, emphasizing the need to find and put into practice new therapies to lower high arterial blood pressure (BP). Among these new methods of treatment, the most promising is the renal sympathetic denervation, showing positive results with the second generation devices. This review summarizes current knowledge about the treatment of RH, with an emphasis on new therapeutic strategies to achieve optimal blood pressure control.

scholarly journals Identifying drug-related attributes to personalise antihypertensive agents: the outcome report of patients receiving metoprolol therapy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chunyu Liu ◽  
Jing Xu ◽  
Ran Liu ◽  
Miye Wang ◽  
Yixuan Zhuo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Control ◽  
Antihypertensive Drugs ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Data Visualisation ◽  
Serum Cystatin C ◽  
Improve Blood Pressure Control

Abstract Background Currently, numerous antihypertensive drugs from different pharmacological classes are available; however, blood pressure control is achieved in only less than a third of patients treated for hypertension. Moreover, providing optimal and personalised treatment for hypertension is challenging. Therefore, in this study, we propose a ‘drug-related attributes’ sensitive spectrum. This novel concept can assist clinicians in selecting an optimal antihypertensive drug and improve blood pressure control after examining the attributes of a patient. Methods We collected clinical data on attributes related to hypertension and its therapy of inpatients from West China Hospital who received metoprolol therapy and constructed the sensitive spectrum using data-visualisation tools. Results Our analysis revealed that haematocrit, haemoglobin, serum creatinine, serum cystatin C, serum urea, age, sex, systolic pressure, diastolic pressure, pulse pressure, and heart rate are metoprolol-related attributes. Conclusion Our study showed that all metoprolol-related attributes identified are reasonable and helpful in improving the personalisation of metoprolol therapy. The proposed drug-related attributes spectrum can help personalise antihypertensive medication. Moreover, data-visualisation tools can be effectively used to mine the drug-related attributes sensitive spectrum.

scholarly journals Improvement of Blood Pressure Control by Adherence Check in Patients With Apparent Treatment-Resistant Hypertension: A Case Series

2020 ◽  
Vol 13 ◽  
pp. 117954762090488
Author(s):  
Keiko Hosohata ◽  
Ayaka Inada ◽  
Saki Oyama ◽  
Takashi Doi ◽  
Iku Niinomi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Case Series ◽  
Pressure Control ◽  
Supporting Evidence ◽  
Treatment Resistant ◽  
Uncontrolled Blood Pressure ◽  
Important Challenge ◽  
Prescribed Medicines

Adherence to medications is an important challenge while treating chronic disease such as resistant hypertension, which is defined as uncontrolled blood pressure (BP) despite treatment with more than 3 antihypertensive drugs to achieve targets. It is possible that poor adherence is the most significant contributor to rates of pseudo-resistance among treated hypertensive patients. In this report, we describe 4 patients with apparent treatment-resistant hypertension, who received intervention to promote adherence by pharmacists who set the prescribed medicines in a weekly medication calendar and conducted a weekly pill count. The results showed that the intervention of pharmacists to medication adherence improved systolic BP in patients with apparent treatment-resistant hypertension; however, further controlled trials are required to strengthen supporting evidence.

Sign in / Sign up

Export Citation Format

Share Document