Causes of Resistant Hypertension Detected by a Standardized Algorithm

Resistant hypertension (RH) is characterized by blood pressure above 140 × 90 mm Hg, despite the use, in appropriate doses, of three antihypertensive drug classes, including a diuretic, or the need of four classes to control blood pressure. Resistant hypertension patients are under a greater risk of presenting secondary causes of hypertension and may be benefited by therapeutical approach for this diagnosis. However, the RH is currently little studied, and more knowledge of this clinical condition is necessary. In addition, few studies had evaluated this issue in emergent countries. Therefore, we proposed the analysis of specific causes of RH by using a standardized protocol in Brazilian patients diagnosed in a center for the evaluation and treatment of hypertension. The management of these patients was conducted with the application of a preformulated protocol which aimed at the identification of the causes of resistant hypertension in each patient through management standardization. The data obtained suggest that among patients with resistant hypertension there is a higher prevalence of secondary hypertension, than that observed in general hypertensive ones and a higher prevalence of sleep apnea as well. But there are a predominance of obesity, noncompliance with diet, and frequent use of hypertensive drugs. These latter factors are likely approachable at primary level health care, since that detailed anamneses directed to the causes of resistant hypertension are applied.

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PENGARUH TERAPI TERTAWA TERHADAP PENURUNAN TEKANAN DARAH LANSIA DI UPT PANTI WREDHA BUDHI DHARMA YOGYAKARTA

Surya Medika: Jurnal Ilmiah Ilmu Keperawatan dan Ilmu Kesehatan Masyarakat ◽

10.32504/sm.v13i1.99 ◽

2019 ◽

Vol 13 (1) ◽

Author(s):

Niken Setyaningrum ◽

Andri Setyorini ◽

Fachruddin Tri Fitrianta

Keyword(s):

Blood Pressure ◽

Data Analysis ◽

The Elderly ◽

Control Group ◽

Group Comparison ◽

Control Blood Pressure ◽

Men And Women ◽

Treatment Of Hypertension ◽

Before And After ◽

The Difference

ABSTRACTBackground: Hypertension is one of the most common diseases, because this disease is suffered byboth men and women, as well as adults and young people. Treatment of hypertension does not onlyrely on medications from the doctor or regulate diet alone, but it is also important to make our bodyalways relaxed. Laughter can help to control blood pressure by reducing endocrine stress andcreating a relaxed condition to deal with relaxation.Objective: The general objective of the study was to determine the effect of laughter therapy ondecreasing elderly blood pressure in UPT Panti Wredha Budhi Dharma Yogyakarta.Methods: The design used in this study is a pre-experimental design study with one group pre-posttestresearch design where there is no control group (comparison). The population in this study wereelderly aged over> 60 years at 55 UPT Panti Wredha Budhi Dharma Yogyakarta. The method oftaking in this study uses total sampling. The sample in this study were 55 elderly. Data analysis wasused to determine the difference in blood pressure before and after laughing therapy with a ratio datascale that was using Pairs T-TestResult: There is an effect of laughing therapy on blood pressure in the elderly at UPT Panti WredhaBudhi Dharma Yogyakarta marked with a significant value of 0.000 (P <0.05)

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Device therapy of resistant hypertension

Orvosi Hetilap ◽

10.1556/oh.2013.29543 ◽

2013 ◽

Vol 154 (6) ◽

pp. 203-208 ◽

Cited By ~ 1

Author(s):

Gábor Simonyi ◽

J. Róbert Bedros ◽

Mihály Medvegy

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Resistant Hypertension ◽

Carotid Sinus ◽

Maximum Tolerated Dose ◽

Reduce Blood Pressure ◽

Nerve Fibers ◽

Uncontrolled Hypertension ◽

Sympathetic Nerve Fibers ◽

Treatment Of Hypertension

It is well known that hypertension is an independent cardiovascular risk factor. Treatment of hypertension frequently includes administration of three or more drugs. Resistant hypertension is defined when blood pressure remains above target value despite full doses (the patient’s maximum tolerated dose) of antihypertensive medication consisting of at least three different classes of drugs including a diuretic. Pharmacological treatment of hypertension is often unsuccessful despite the increasing number of drug combinations. Uncontrolled hypertension, however, increases the cardiovascular risk. Device treatment of resistant hypertension is currently testing two major fields. One of them the stimulation of baroreceptors in the carotid sinus and the other is radiofrequency ablation of sympathetic nerve fibers around renal arteries to reduce blood pressure in drug resistant hypertension. Orv. Hetil., 2013, 154, 203–208.

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The Road to Better Management in Resistant Hypertension–Diagnostic and Therapeutic Insights

Pharmaceutics ◽

10.3390/pharmaceutics13050714 ◽

2021 ◽

Vol 13 (5) ◽

pp. 714

Author(s):

Elisabeta Bădilă ◽

Cristina Japie ◽

Emma Weiss ◽

Ana-Maria Balahura ◽

Daniela Bartoș ◽

...

Keyword(s):

Blood Pressure ◽

Resistant Hypertension ◽

Renin Angiotensin System ◽

Drug Regimen ◽

Secondary Hypertension ◽

Adverse Outcomes ◽

Uncontrolled Hypertension ◽

White Coat Hypertension ◽

Mineralocorticoid Receptor Antagonist ◽

Mortality And Morbidity

Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to lower blood pressure below 140/90 mmHg despite adequate lifestyle measures and optimal treatment with at least three medications, including a diuretic, and usually a blocker of the renin-angiotensin system and a calcium channel blocker, at maximally tolerated doses. Hereby, we discuss the diagnostic and therapeutic approach to a better management of R-HTN. Excluding pseudoresistance, secondary hypertension, white-coat hypertension and medication non-adherence is an important step when diagnosing R-HTN. Most recently different phenotypes associated to R-HTN have been described, specifically refractory and controlled R-HTN and masked uncontrolled hypertension. Optimizing the three-drug regimen, including the diuretic treatment, adding a mineralocorticoid receptor antagonist as the fourth drug, a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when failing to achieve target blood pressure values are current recommendations regarding the correct management of R-HTN.

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Guest Editorial: Challenges in Resistant Hypertension

European Cardiology Review ◽

10.15420/ecr.2016:20:1 ◽

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.

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Angiotensinogen and the Modulation of Blood Pressure

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.645123 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zimei Shu ◽

Jiahui Wan ◽

Randy J. Read ◽

Robin W. Carrell ◽

Aiwu Zhou

Keyword(s):

Blood Pressure ◽

Redox Status ◽

Control Blood Pressure ◽

Physiological Regulation ◽

Temperature Changes ◽

Amino Terminal ◽

Angiotensin Peptides ◽

Allosteric Mechanism ◽

Treatment Of Hypertension ◽

Crystallographic Structures

The angiotensin peptides that control blood pressure are released from the non-inhibitory plasma serpin, angiotensinogen, on cleavage of its extended N-terminal tail by the specific aspartyl-protease, renin. Angiotensinogen had previously been assumed to be a passive substrate, but we describe here how recent studies reveal an inherent conformational mechanism that is critical to the cleavage and release of the angiotensin peptides and consequently to the control of blood pressure. A series of crystallographic structures of angiotensinogen and its derivative forms, together with its complexes with renin show in molecular detail how the interaction with renin triggers a profound shift of the amino-terminal tail of angiotensinogen with modulation occurring at several levels. The tail of angiotensinogen is restrained by a labile disulfide bond, with changes in its redox status affecting angiotensin release, as demonstrably so in the hypertensive complication of pregnancy, pre-eclampsia. The shift of the tail also enhances the binding of renin through a tail-in-mouth allosteric mechanism. The N-terminus is now seen to insert into a pocket equivalent to the hormone-binding site on other serpins, with helix H of angiotensinogen unwinding to form key interactions with renin. The findings explain the precise species specificity of the interaction with renin and with variant carbohydrate linkages. Overall, the studies provide new insights into the physiological regulation of angiotensin release, with an ability to respond to local tissue and temperature changes, and with the opening of strategies for the development of novel agents for the treatment of hypertension.

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Secondary causes of hypertension

ESC CardioMed ◽

10.1093/med/9780198784906.003.0566 ◽

2018 ◽

pp. 2409-2419

Author(s):

Isabella Sudano ◽

Felix Beuschlein ◽

Thomas F. Lüscher

Keyword(s):

Blood Pressure ◽

Family History ◽

Arterial Hypertension ◽

Late Onset ◽

Young Patients ◽

Secondary Hypertension ◽

Clinical Findings ◽

Age Group ◽

History Of ◽

Secondary Causes

Secondary hypertension may be defined as a type of hypertension (i.e. blood pressure >140/90 mmHg) with an underlying, potentially correctable cause. Secondary hypertension should be particularly considered in (1) young patients without a family history of arterial hypertension, (2) patients with resistant hypertension, and (3) late onset of hypertension. In addition to the medical history, a secondary aetiology may be suspected in the presence of symptoms (e.g. flushing and sweating suggestive of phaeochromocytoma), clinical findings (e.g. a renal bruit suggestive of renal artery stenosis), or laboratory abnormalities (e.g. hypokalaemia suggestive of hyperaldosteronism). Approximately 5% of adults with hypertension have a secondary cause. The prevalence of secondary hypertension and the most common aetiologies vary by age group. This chapter aims to summarize the principal causes of secondary hypertension, how these may be diagnosed and their specific treatments.

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Diagnosis of Resistant Hypertension

Northern International Medical College Journal ◽

10.3329/nimcj.v8i1.32398 ◽

2017 ◽

Vol 8 (1) ◽

pp. 196-198

Author(s):

Moniruzzaman Khan ◽

Sharif Shaila Islam

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Resistant Hypertension ◽

Antihypertensive Agents ◽

Cardiovascular Death ◽

Uncontrolled Hypertension ◽

Elevated Blood ◽

Medical College ◽

Obstructive Sleep ◽

Secondary Causes

Hypertension is a major risk factor of cardiovascular death in Bangladesh and worldwide. Resistant hypertension as well as uncontrolled hypertension with 3 or more antihypertensive agents is increasingly common in clinical practice. Clinicians should exclude pseudoresistant hypertension, which results from nonadherence to medications or from elevated blood pressure related to the white coat syndrome. Resistant hypertension may be associated with secondary causes of hypertension including obstructive sleep apnea or primary aldosteronism.Northern International Medical College Journal Vol.8(1) July 2016: 196-198

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Who should be screened for secondary causes of hypertension?

Clinical Management Issues ◽

10.7175/cmi.v5i4.498 ◽

2011 ◽

Vol 5 (4) ◽

pp. 157-164

Author(s):

Andrea Semplicini ◽

Chiara Sandonà ◽

Federica Stella ◽

Tommaso Grandi

Keyword(s):

Arteriovenous Fistula ◽

Resistant Hypertension ◽

Kidney Biopsy ◽

Secondary Hypertension ◽

Uncontrolled Hypertension ◽

Hypertensive Patients ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up ◽

Secondary Causes

The case of a 34-year-old patient with uncontrolled hypertension is described in this article, together with the diagnostic path followed in order to make the diagnosis, that finally reveals an arteriovenous fistula due to an old kidney biopsy. Uncontrolled or resistant hypertension may be caused by unrecognized secondary hypertension: we revise the clinical and laboratory criteria for selecting hypertensive patients in whom to look for secondary hypertension through the most appropriate diagnostic work up. A synthesis of the main causes of secondary hypertension is also provided in the discussion.

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Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older from the American College of Physicians and the American Academy of Family Physicians

Journal of Contemporary Pharmacy Practice ◽

10.37901/jcphp17-00017 ◽

2019 ◽

Vol 66 (2) ◽

pp. 50-54

Author(s):

Eric Pinashin ◽

Craig Stern

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Normal Values ◽

Family Physicians ◽

Organ Damage ◽

Secondary Hypertension ◽

Endocrine Disorders ◽

Low Blood Pressure ◽

Treatment Of Hypertension ◽

Untreated Hypertension

An elevation in systolic and diastolic blood pressure, known as hypertension, is characterized as a condition where blood pressure values are above the normal values, ranging around 120/80mmHg for most adults. There are two forms of hypertension, primary hypertension and secondary hypertension. Primary or essential hypertension accounts for 90–95% of patients with hypertension, with its etiology unknown, while secondary hypertension accounts for 5–10% of the population, due to chronic kidney disease, endocrine disorders, or usage of ibuprofen or venlafaxine.(1) If left untreated, hypertension can lead to heart attack, stroke, heart failure, vision problems, kidney damage, and a variety of other problems, depending on which vessels it affects. As seen in Figure 1, either having low or high systolic or diastolic blood pressure can be detrimental to one's health. Having low blood pressure can lead to hypoperfusion of vital organs, whereas elevated blood pressure can lead to end organ damage, stroke, and myriad related instances.

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The Current Status of Devices for the Treatment of Resistant Hypertension

American Journal of Hypertension ◽

10.1093/ajh/hpz161 ◽

2019 ◽

Vol 33 (1) ◽

pp. 10-18

Author(s):

Michael Kunz ◽

Lucas Lauder ◽

Sebastian Ewen ◽

Michael Böhm ◽

Felix Mahfoud

Keyword(s):

Blood Pressure ◽

Resistant Hypertension ◽

Treatment Options ◽

Pressure Control ◽

Current Status ◽

Baroreflex Activation Therapy ◽

Major Cardiovascular Events ◽

Cardiovascular Morbidity And Mortality ◽

Treatment Of Hypertension ◽

Activation Therapy

Abstract Arterial hypertension is associated with increased cardiovascular morbidity and mortality. Although blood pressure-lowering therapies significantly reduce the risk of major cardiovascular events, blood pressure control remains unsatisfactorily low. Several device-based antihypertensive therapies have been investigated in patients with treatment-resistant hypertension and in patients unable or unwilling to adhere to antihypertensive medication. As the field of device-based therapies is subject to constant change, this review aims at providing an up-to-date overview of different device-based approaches for the treatment of hypertension. These approaches target the sympathetic nervous system (renal denervation, baroreflex amplification therapy, baroreflex activation therapy, and carotid body ablation) or alter mechanical arterial properties by creating an iliac arteriovenous fistula. Notably, the use of all of these treatment options is not recommended for the routine treatment of hypertension by current guidelines but should be investigated in the context of controlled clinical studies.

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