Multidisciplinary Approach in the Treatment of Resistant Hypertension

Abstract

With its high prevalence and the eminent number of undetected or poorly controlled patients, the management of arterial hypertension is still a challenging task. Uncontrolled blood pressure is the major adjustable risk factor for cardiovascular end organ damage for coronary heart disease, heart failure, stroke, and renal disease. Patients with resistant hypertension often need a multidisciplinary approach in order to control their blood pressure sustainably. In cooperation with hypertension specialists, the underlying cause for therapy resistance should be evaluated. Pseudohypertension, white coat hypertension, and non-adherence need to be addressed. The medication can often be optimized and simplified. Reducing the number of pills per day can enhance the drug-adherence remarkably. The multidisciplinary evaluation of secondary causes of hypertension includes an endocrinological work-up, ruling out relevant sleeping disorders, and renal diagnostics. If there are no causative treatments possible and pharmacological and non-pharmacological measurements are not sufficient to control the blood pressure, one has to consider multidisciplinary approaches bringing nurses, pharmacists, dieticians, physiotherapists, social workers, psychologists, and community health workers onboard. Utilizing various strategies might improve medication management, patient follow-up, adherence, and self-management. Interventional therapy such as renal renervation, baroreflex activation therapy, or carotid body modulation is the final option that can be discussed with interventional active colleagues. However, large randomized controlled trials proving a benefit of these interventional therapies are still missing. The use of these still experimental approaches should be restricted to randomized controlled trials accordingly.

Keywords: Adherence to therapy; Interventional therapy; Resistant hypertension; Secondary hypertension.