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Review
. 2022 Jul;24(7):225-234.
doi: 10.1007/s11906-022-01185-6. Epub 2022 Apr 6.

An Update on Refractory Hypertension

Faris Matanes  1 , M Bilal Khan  2 , Mohammed Siddiqui  2 , Tanja Dudenbostel  2 , David Calhoun  2 , Suzanne Oparil  2
Affiliations
Review

An Update on Refractory Hypertension

Faris Matanes et al. Curr Hypertens Rep. 2022 Jul.

Abstract

Purpose of review: To update on definition, diagnosis, prevalence, patient characteristics, pathophysiology, and treatment of refractory hypertension (RfHTN).

Recent findings: Refractory hypertension (RfHTN) is defined as blood pressure (BP) that is uncontrolled despite using ≥ 5 antihypertensive medications of different classes, including a long-acting thiazide diuretic and a mineralocorticoid receptor antagonist (MRA) at maximal or maximally tolerated doses. This new phenotype is different from resistant hypertension (RHTN), defined as BP that is uncontrolled despite using ≥ 3 medications, commonly a long-acting calcium channel blocker (CCB), a blocker of the renin-angiotensin system (angiotensin-converting enzyme [ACE] inhibitor or angiotensin receptor blocker [ARB]), and a diuretic. The RHTN phenotype includes controlled RHTN, BP that is controlled on 4 or more medications. RfHTN is largely attributable to increased sympathetic activity, unlike RHTN, which is mainly due to increased intravascular fluid volume frequently caused by hyperaldosteronism and chronic excessive sodium ingestion. Compared to those with controlled RHTN, patients with RfHTN have a higher prevalence of target organ damage and do not have elevated aldosterone levels. Ongoing clinical trials are assessing the safety and efficacy of using devices to aid with BP control in patients with RfHTN. RfHTN is a separate entity from RHTN and is generally attributable to increased sympathetic activity.

Keywords: Primary aldosteronism; Renal denervation; Sleep apnea; Spironolactone; Sympathetic activation.

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Conflict of interest statement

Faris Matanes reports grants from NIH during the conduct of the study. Suzanne Oparil declares the following Editor-in-Chief, Current Hypertension Reports (Journal; Publisher – Springer Science Business Media LLC); annual stipend of $5,000 (Springer); Editor-in-Chief Term until 12/2022. M. Bilal Khan, Mohammed Siddiqui, Tanja Dudenbostel, and David Calhoun declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Graph illustrating the phenotypes of hypertension
See this image and copyright information in PMC

References

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