scholarly journals Recent advances in understanding and managing resistant/refractory hypertension

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 169 ◽  
Author(s):  
Michael Doumas ◽  
Konstantinos P Imprialos ◽  
Manolis S Kallistratos ◽  
Athanasios J Manolis
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Uncontrolled Hypertension ◽  
Renal Sympathetic Denervation ◽  
Refractory Hypertension ◽  
European Guidelines ◽  
Carotid Baroreceptor ◽  
Activation Therapy ◽  
Baroreceptor Activation ◽  
Line Drug

The management of resistant hypertension presents several challenges in everyday clinical practice. During the past few years, several studies have been performed to identify efficient and safe pharmacological and non-pharmacological options for the management of such patients. The Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2) trial demonstrated significant benefits with the use of spinorolactone as a fourth-line drug for the treatment of resistant hypertension over doxazosin and bisoprolol. In addition, recent data support that spironolactone may demonstrate superiority over central acting drugs in such patients, as well. Based on the European guidelines, spironolactone is recommended as the fourth-line drug option, followed by amiloride, other diuretics, doxazosin, bisoprolol or clonidine.  Among several device-based approaches, renal sympathetic denervation had fallen into hibernation after the disappointing results of the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN) 3 trial. However, the technique re-emerged at the epicenter of the clinical and research interest after the favorable results of three sham-controlled studies, which facilitated novel catheters and techniques to perform the denervation. Significant results of iliac anastomosis on blood pressure levels have also been demonstrated. Nevertheless, the technique-related adverse events resulted in withdrawal of this interventional approach. Last, the sympatholytic properties of the carotid baroreceptor activation therapy were associated with significant blood pressure reductions in patients with resistant hypertension, which need to be verified in larger controlled trials. Currently device-based approaches are recommended only in the setting of clinical trials until more safety and efficacy data become available.

Resistant hypertension: new insights and therapeutic perspectives

2019 ◽  
Vol 6 (3) ◽  
pp. 188-193 ◽  
Author(s):  
Luis M Ruilope ◽  
Elena Rodríguez-Sánchez ◽  
José Alberto Navarro-García ◽  
Julian Segura ◽  
Alberto Órtiz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Resistant Hypertension ◽  
Clinical Relevance ◽  
Uncontrolled Hypertension ◽  
Refractory Hypertension ◽  
Current Drug ◽  
Different Types ◽  
Future Treatments ◽  
Definition Of

Abstract Resistant hypertension (RH) is a concept that currently goes beyond the classical definition of blood pressure ≥140/90 mmHg in subjects receiving three or more drugs of different classes at maximally tolerated doses. Here, we review the clinical relevance of RH and the different types of RH-associated phenotypes, namely refractory hypertension, controlled resistant hypertension, and masked uncontrolled hypertension. We also discuss current drug strategies and future treatments for these high-risk phenotypes.

Interventional Therapies for Resistant Hypertension: A Brief Update

2016 ◽  
Vol 11 (1) ◽  
pp. 65
Author(s):  
Lisa Brandon ◽  
◽  
◽  
Faisal Sharif
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Management Options ◽  
Arteriovenous Shunts ◽  
Significant Difference ◽  
Activation Therapy ◽  
Renal Artery Denervation ◽  
Baroreceptor Activation ◽  
And Control ◽  
Interventional Therapies

Resistant hypertension remains a clinical challenge with few management options beyond maximisation of medications. Catheterbased renal artery denervation (RDN) was proposed in 2009 as a possible therapy for resistant hypertension and early feasibility trials caused excitement among cardiologists and antihypertensive specialists, showing remarkable and sustained blood pressure reductions. In 2014, enthusiasm for RDN dampened following the SYMPLICITY 3 trial results, which showed no statistically significant difference in blood pressure between the intervention and control arms. However, hope remains for the improved management of resistant hypertension; procedural understanding, technological advancements and alternative targets – such as baroreceptor activation therapy and arteriovenous shunts – may aid the identification of those patients for whom specific interventional therapies will be effective.

scholarly journals Benefits from Treatment and Control of Patients with Resistant Hypertension

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Michael Doumas ◽  
Vasilios Papademetriou ◽  
Stella Douma ◽  
Charles Faselis ◽  
Konstantinos Tsioufis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Critical Evaluation ◽  
Renal Sympathetic Denervation ◽  
Therapeutic Modalities ◽  
Carotid Baroreceptor ◽  
Baroreceptor Stimulation ◽  
And Control ◽  
Renal Sympathetic ◽  
Carotid Baroreceptor Stimulation

Resistant hypertension is commonly found in everyday clinical practice. However, the risks of resistant hypertension, as well as the benefits of treatment and control of blood pressure in patients with resistant hypertension remain vaguely clarified. Data from small clinical studies and observational cohorts suggest that patients with resistant hypertension are at increased cardiovascular risk, while control of blood pressure offers substantial benefits. It has to be noted however that data from appropriate large randomized studies are missing, and resistant hypertension remains remarkably understudied. Resistant hypertension has attracted significant scientific interest lately, as new therapeutic modalities become available. The interventional management of resistant hypertension either by carotid baroreceptor stimulation or renal sympathetic denervation is currently under investigation with promising preliminary results. This review presents available evidence regarding the benefits of treatment and control of blood pressure in patients with resistant hypertension and offers a critical evaluation of existing data in this field.

scholarly journals Resistant Hypertension Workup and Approach to Treatment

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Anastasios Makris ◽  
Maria Seferou ◽  
Dimitris P. Papadopoulos
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Blood Pressure Measurement ◽  
Antihypertensive Agents ◽  
White Coat ◽  
Clinical Inertia ◽  
Uncontrolled Hypertension ◽  
White Coat Hypertension ◽  
Carotid Baroreceptor ◽  
Interventional Therapies

Resistant hypertension is defined as blood pressure above the patient's goal despite the use of 3 or more antihypertensive agents from different classes at optimal doses, one of which should ideally be a diuretic. Evaluation of patients with resistive hypertension should first confirm that they have true resistant hypertension by ruling out or correcting factors associated with pseudoresistance such as white coat hypertension, suboptimal blood pressure measurement technique, poor adherence to prescribed medication, suboptimal dosing of antihypertensive agents or inappropriate combinations, the white coat effect, and clinical inertia. Management includes lifestyle and dietary modification, elimination of medications contributing to resistance, and evaluation of potential secondary causes of hypertension. Pharmacological treatment should be tailored to the patient's profile and focus on the causative pathway of resistance. Patients with uncontrolled hypertension despite receiving an optimal therapy are candidates for newer interventional therapies such as carotid baroreceptor stimulation and renal denervation.

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 Interventional Therapies for Resistant Hypertension: A Brief Update

2016 ◽  
Vol 11 (1) ◽  
pp. 65
Author(s):  
Lisa Brandon ◽  
◽  
◽  
Faisal Sharif
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Management Options ◽  
Arteriovenous Shunts ◽  
Significant Difference ◽  
Activation Therapy ◽  
Renal Artery Denervation ◽  
Baroreceptor Activation ◽  
And Control ◽  
Interventional Therapies

Resistant hypertension remains a clinical challenge with few management options beyond maximisation of medications. Catheterbased renal artery denervation (RDN) was proposed in 2009 as a possible therapy for resistant hypertension and early feasibility trials caused excitement among cardiologists and antihypertensive specialists, showing remarkable and sustained blood pressure reductions. In 2014, enthusiasm for RDN dampened following the SYMPLICITY 3 trial results, which showed no statistically significant difference in blood pressure between the intervention and control arms. However, hope remains for the improved management of resistant hypertension; procedural understanding, technological advancements and alternative targets – such as baroreceptor activation therapy and arteriovenous shunts – may aid the identification of those patients for whom specific interventional therapies will be effective.

New Hope for Resistant Hypertention

2012 ◽  
Vol 5 (1) ◽  
pp. 81-91
Author(s):  
Z Rahman ◽  
KK Karmaker ◽  
M Ahmed ◽  
M Aziz ◽  
S Chowdhury ◽  
...  
Keyword(s):  
Resistant Hypertension ◽  
Patient Adherence ◽  
Public Health Problem ◽  
Drug Regimen ◽  
Renal Sympathetic Denervation ◽  
Major Public Health Problem ◽  
Antihypertensive Medications ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy ◽  
Increasing Trends

Hypertension is a major public health problem. Despite the increasing awareness of hypertension and its implications among patients and treating physicians, the prevalence of resistant hypertension    remains high.Resistant hypertension define as blood pressure that remains elevated above treatment goals despite administration of an optimal three drug regimen that include a diuretic1 The prevalence of resistant    hypertension is projected to increase, owing to the aging population and increasing trends in obesity, sleep apnea, and chronic kidney disease. It is estimated that at least 10% of all patients with hypertension are resistant to existing drugs. Management of resistant hypertension must begin with  a careful evaluation of the patient to confirm the diagnosis and exclude factors associated with “pseudo-resistance,” such as improper BP measurement technique, the white-coat effect, and poor patient adherence to life-style and/or antihypertensive medications. Despite the use of the appropriate dose and type of diuretic to overcome the management of resistant hypertension, we can’t achieve our goal. But there is at least two devices namely Baroreflex Activation Therapy and Catheter-based  renal sympathetic denervation make the new hope for the patient with resistant hypertension DOI: http://dx.doi.org/10.3329/cardio.v5i1.12278 Cardiovasc. j. 2012; 5(1): 81-91

Device therapy of resistant hypertension

2013 ◽  
Vol 154 (6) ◽  
pp. 203-208 ◽  
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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