scholarly journals Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management

2021 ◽  
Vol 93 (9) ◽  
pp. 1018-1029
Author(s):  
Anna V. Aksenova ◽  
Olga A. Sivakova ◽  
Nataliia V. Blinova ◽  
Nikolai M. Danilov ◽  
Evgeniia M. Elfimova ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Resistant Hypertension ◽  
Lifestyle Changes ◽  
Diagnostic Methods ◽  
Medical Society ◽  
Hypertension Detection ◽  
Improve Blood Pressure Control ◽  
Obstructive Sleep ◽  
Radiofrequency Denervation ◽  
Resistant Arterial Hypertension

The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.

scholarly journals Rational combination therapy in resistant arterial hypertension

2011 ◽  
Vol 17 (4) ◽  
pp. 384-390
Author(s):  
I. V. Emelianov ◽  
A. O. Konradi
Keyword(s):  
Combination Therapy ◽  
Arterial Hypertension ◽  
Resistant Hypertension ◽  
Drug Resistant ◽  
Therapeutic Approaches ◽  
Rational Combination ◽  
Resistant Arterial Hypertension

The article reviews therapy in drug-resistant hypertension. Current therapeutic approaches to treatment and rational combination therapy are discussed.

Ambulatory screening for obstructive sleep apnea in patients with resistant arterial hypertension

2017 ◽  
Vol 22 (2) ◽  
pp. 361-367
Author(s):  
Monika Kamasová ◽  
Jan Václavík ◽  
Tomáš Václavík ◽  
Milada Hobzová ◽  
Eva Kociánová ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Hypertension ◽  
Obstructive Sleep ◽  
Resistant Arterial Hypertension

scholarly journals Radiofrequency denervation of the renal arteries in patients with resistant arterial hypertension: 3 years of observation experience

2019 ◽  
Vol 16 (4) ◽  
pp. 65-69
Author(s):  
Nina Yu Savelyeva ◽  
Anna Yu Zherzhova ◽  
Ekaterina V Mikova ◽  
Liudmila I Gapon ◽  
Grigorii V Kolunin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Blood Pressure Monitoring ◽  
Secondary Hypertension ◽  
Renal Arteries ◽  
Radiofrequency Denervation ◽  
Intact Kidney ◽  
Resistant Arterial Hypertension

Objective. To evaluate the efficiency of radiofrequency denervation of the renal arteries in patients with resi-stant arterial hypertension during a three-year follow-up. Materials and methods. The study involved 40 patients with resistant arterial hypertension aged 27 to 70 years (mean age 54.91±9.77 years) while receiving three or more antihypertensive drugs (including diuretic) in optimal doses. The conditions for inclusion in the study were considered resistant arterial hypertension with blood pressure (BP)>160/100 mm Hg, intact kidney function - glomerular filtration rate (MDRD)>45 ml/min - and the absence of secondary hypertension. All patients had sympatic radiofrequency denervation of renal arteries; its efficiency later was estimated according to the clinical measurement and ambulatory blood pressure monitoring (ABPM). Results. The level of office BP reliably differed initially and after 3 years: DSBP -34.48±6.44 mm Hg (p=0.001), DDBP - 22.29 mm Hg (p=0.001). According to ABPM results, reliable dynamics of systolic blood pressure was not observed. The data of DBP at night were significantly lower after 36 months; DDBP was -5.37±9.77 mm Hg. Conclusions. A marked decrease in the data of office SBP and DBP was observed, which proves the long-term efficiency of radiofrequency denervation of the renal arteries in patients with resistant hypertension. Accor-ding to ABPM results after 36 months, a significant decrease was registered among the DBP indicators at night and daytime.

Abstract P255: Resistance Hypertension And Achievement Of Target Blood Pressure Level By Continuous Positive Airway Pressure Long Therapy In Patients With Obstructive Sleep Apnea

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Oksana Rekovets ◽  
Yuriy Sirenko ◽  
Nina Krushynska ◽  
Olena Torbas ◽  
Svitlana Kushnir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Arterial Hypertension ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Obstructive Sleep ◽  
Resistant Arterial Hypertension

The aim was to assess the arterial stiffness changes in patients with resistant arterial hypertension (AH) and obstructive sleep apnea (OSA) and possibilities of its correction by continuous positive airway pressure (CPAP)-therapy. Design: In 10 month follow-up study were included 46 patients with RAH, who were divided into groups: 1-st - patients with RAH and moderate to severe OSA on CPAP (n=21); 2-nd - patients with RAH and moderate to severe OSA without CPAP (n=25). They underwent somnography by dual-channel portable monitor device, office and ambulatory blood pressure monitoring, echocardiography and applanation tonometry. All patients received similar antihypertensive therapy according to 2013 ESH Guidelines for the management of arterial hypertension. Results: Patients with RAH and OSA (mean apnea-hypopnea index (AHI) 36.5±2.7 event h-1) in comparison with patients with RAH without OSA (mean AHI 3.4±0.2 event h-1) had significantly higher body mass index (34.2±0.7 vs 31.6±0.7 kg m-2, P<0.05), uric acid level (6.7±0.1 vs 5.6±0.4 mg dl-1, P<0,05)). Patients with RAH and OSA in comparison with patients with RAH without OSA had higher carotid-femoral pulse wave velocity (PWVcf) (12.1±0.5 vs 10.2 m s-1, P<0,05) and central systolic blood pressure (CSBP) (143.8±2.7 vs 136.2±3.4 mm Hg, P<0,05). During 10 months follow-up in patients with RAH and moderate and sever OSA on CPAP-therapy there were significantly decrease of PWVcf (from 12.1±0.5 to 10.5±0.5 m s-1, P<0,05), decrease office systolic blood pressure (from 147.8±3.7 to 136.7±2.8 mm Hg; P<0,05) and diastolic blood pressure (from 96.8±3.5 to 87.0±3.3 mm Hg; P<0,05) with achievement of target levels in 67,2% patients. Central systolic BP decreased (from 143.8±2.7 to 137.7±2.8 mm Hg; P<0,05). Conclusion: The combination of therapy continuous positive airway pressure with antihypertensive treatment in patients with resistant arterial hypertension and moderate to severe obstructive sleep apnea improved achievement of target blood pressure, decreased arterial stiffness and decreased central blood pressure.

scholarly journals Resistant arterial hypertension

2021 ◽  
Vol 23 (1) ◽  
pp. 28-31
Author(s):  
Anton V. Rodionov ◽  
◽  
Ivan G. Yudin ◽  
Viktor V. Fomin ◽  
◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Renal Denervation ◽  
Antihypertensive Drugs ◽  
Blood Pressure Measurement ◽  
Sleep Apnea Syndrome ◽  
Significant Proportion ◽  
Secondary Hypertension ◽  
High Dose ◽  
Obstructive Sleep ◽  
Resistant Arterial Hypertension

The review provides modern data on the examination and treatment tactics of patients with resistant arterial hypertension (RAH). The prevalence of RAH is about 10–15%, with a significant proportion of pseudo-resistance cases associated with low adherence to therapy, inaccurate blood pressure measurement technique, and increased arterial stiffness in the elderly. In patients with RAH, it is necessary to exclude secondary hypertension, of which drug hypertension associated with the use of nonsteroidal anti-inflammatory drugs, nasal sympathomimetics, oral contraceptives, as well as those caused by obstructive sleep apnea syndrome or primary hyperaldosteronism are prevalent. Secondary hypertension is often asymptomatic, therefore, additional examination is required for patients without the classic signs of these diseases. Pharmacotherapy of RAH includes a high-dose combination of antihypertensive drugs. In the first instance, first-line drugs (the renin-angiotensin system blockers, calcium antagonists, thiazide diuretics) should be combined with mineralocorticoid receptor antagonists, which have a good evidence base (PATHWAY-2, ReHOT studies), and then other reserve drugs. The study of interventional methods for the treatment of RAH continues. To date, the effectiveness of renal denervation has been proven. The study of the method of carotid baroreflex amplification continues. Keywords: arterial hypertension, resistant arterial hypertension, secondary arterial hypertension, antihypertensive therapy, renal denervation For citation: Rodionov AV, Yudin IG, Fomin VV. Resistant arterial hypertension. Consilium Medicum. 2021; 23 (1): 28–31. DOI: 10.26442/20751753.2021.1.200697

scholarly journals Resistant Hypertension and Cardiorenovascular Risk

2017 ◽  
Vol 15 (1) ◽  
pp. 6-9 ◽  
Author(s):  
Ingrid Prkacin ◽  
Petra Vrdoljak ◽  
Gordana Cavric ◽  
Damir Vazanic ◽  
Petra Pervan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Sodium Intake ◽  
Cardiovascular Prevention ◽  
Lifestyle Changes ◽  
Renal Sympathetic Denervation ◽  
Mineralocorticoid Receptor Antagonist ◽  
Obstructive Sleep ◽  
Modifiable Factors

AbstractStudies have documented independent contribution of sympathetic activation to the cardiovascular disease continuum. Hypertension is one of the leading modifiable factors. Most if not all the benefit of antihypertensive treatment depends on blood pressure lowering, regardless how it is obtained. Resistant hypertension is defined as blood pressure that remains uncontrolled in spite of the concurrent use of three antihypertensive drugs of different classes. Ideally, one of the three drugs should be a diuretic, and all drugs should be prescribed at optimal dose amounts. Poor adherence to antihypertensive therapy, undiscovered secondary causes (e.g. obstructive sleep apnea, primary aldosteronism, renal artery stenosis), and lifestyle factors (e.g. obesity, excessive sodium intake, heavy alcohol intake, various drug interactions) are the most common causes of resistant hypertension. Cardio(reno)vascular morbidity and mortality are significantly higher in resistant hypertensive than in general hypertensive population, as such patients are typically presented with a long-standing history of poorly controlled hypertension. Early diagnosis and treatment is needed to avoid further end-organ damage to prevent cardiorenovascular remodeling. Treatment strategy includes lifestyle changes, adding a mineralocorticoid receptor antagonist, treatment adherence in cardiovascular prevention and, in case of failure to control blood pressure, renal sympathetic denervation or baroreceptor activation therapy. The comparative outcomes in resistant hypertension deserve better understanding. In this review, the most current approaches to resistant hypertension and cardiovascular risk based on the available literature evidence will be discussed.

scholarly journals Correlation arterial stiffness and central blood pressure with obstructive sleep apnea in patients with resistant arterial hypertension

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Rekovets ◽  
Y Sirenko ◽  
N Krushynska ◽  
O Torbas ◽  
S Kushnir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Aortic Stiffness ◽  
Pulse Wave ◽  
Central Blood Pressure ◽  
Nocturnal Hypoxemia ◽  
Obstructive Sleep ◽  
Resistant Arterial Hypertension

Abstract   The aim assess correlation the arterial stiffness in patients with resistant arterial hypertension (AH) and obstructive sleep apnea (OSA) Design 185 patients with AH were enrolled into the study. They were divided on 2 groups: OSA group – 148 patients were found to have OSA, indicated by at mean AHI of 38.1±2.5 h–1, and control group – 37 patients without OSA, mean AHI 3.02±0.25 h–1 (P&lt;0.001). Patients of both groups were comparable on age, growth, total cholesterol level and office systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results Patients with RAH and OSA (mean apnea-hypopnea index (AHI) 36.5±2.7 event/h) in comparison with patients with RAH without OSA (mean AHI 3.4±0.2 event/h) had significantly higher body mass index (34.2±0.7 vs 31.6±0.7 kg/m2, P&lt;0.05), uric acid level (6.7±0.1 vs 5.6±0.4 mg/dl, P&lt;0,05), higher carotid-femoral pulse wave velocity (PWVcf) (12.1±0.5 vs 10.2 m/s, P&lt;0,05) and central systolic blood pressure (CSBP) (143.8±2.7 vs 136.2±3.4 mm Hg, P&lt;0,05). Patients of both groups had comparable office blood pressure (SBP 145.6±1.67 vs 138.4±3.66 mm Hg, P=0.057 and DBP 93.6+±1.18 vs 89.1±2.11 mm Hg, P=0.073), but significantly higher 24-h systolic and diastolic blood pressure. We suggest that in the study some patients with OSA had masked arterial hypertension. Daytime sleepiness in OSA patients was associated with structural remodeling of the left ventricle myocardium and more expressed arterial stiffness: ESS score was independently correlated with snoring duration (β=−0.008; P=0.021), interventricular septum thickness (β=0.023; P=0.026), LVMI (β=−0.037; P=0.039) and indexes of central pulse wave: ejection duration (ED) (β=−0.020; P&lt;0.001) and subendocardial viability ratio (SEVR) (β=−0.224; P=0.012). Nocturnal hypoxemia in OSA patients was associated with increased aortic stiffness and higher central blood pressure: desaturation index was independently correlated with Aix (β=4.167; P=0.009), Aix75 (β=−3.929; P=0.006) and central DBP (β=0.151; P=0.004). Conclusion In patients with RH and OSA nocturnal hypoxemia correlation with increased aortic stiffness and higher central blood pressure. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Primary aldosteronism and resistant arterial hypertension

2012 ◽  
Vol 18 (6) ◽  
pp. 514-521 ◽  
Author(s):  
N. E. Zvartau ◽  
L. S. Korostovtseva ◽  
I. V. Emelyanov ◽  
Yu. V. Sviryaev
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Antihypertensive Treatment ◽  
Organ Damage ◽  
Aldosterone Level ◽  
Pathophysiological Mechanisms ◽  
Obstructive Sleep ◽  
Resistant Arterial Hypertension

The review discusses the new data about primary aldosteronism and the connection between increase of aldosterone level and resistance to antihypertensive treatment, including patients with obstructive sleep apnea. Also the main pathophysiological mechanisms underlying the progression of end organ damage and leading to resistance to antihypertensive treatment in patients with high aldosterone level are presented.

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