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Practice Guideline
. 2025 Jan;39(1):1-14.
doi: 10.1038/s41371-024-00983-6. Epub 2024 Dec 9.

Investigation and management of resistant hypertension: British and Irish Hypertension Society position statement

Luca Faconti  1 , Jacob George  2 , Sarah Partridge  3 , Carmen Maniero  4 , Abilash Sathyanarayanan  5 , Spoorthy Kulkarni  6 , Vikas Kapil  4   7 , Alfredo Petrosino  8 , Philip Lewis  9 , Terry McCormack  10 , Neil R Poulter  11 , Anthony Heagerty  12 , Ian B Wilkinson  6
Affiliations
Practice Guideline

Investigation and management of resistant hypertension: British and Irish Hypertension Society position statement

Luca Faconti et al. J Hum Hypertens. 2025 Jan.

Abstract

People living with resistant hypertension (RH) are at high risk of adverse cardiovascular events. The British and Irish Hypertension Society has identified suspected RH as a condition for which specialist guidance may improve rates of blood pressure control and help clinicians identify those individuals who may benefit from specialist review. In this position statement we provide a practical approach for the investigation and management of adults with RH. We highlight gaps in the current evidence and identify important future research questions. Our aim is to support the delivery of high-quality and consistent care to people living with RH across the UK and Ireland.

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Conflict of interest statement

Competing interests: Professor Adrian J.B. Brady has received honoraria from Daiichi-Sankyo, Amgen, Sanofi-Aventis, Bayer, MSD, and Novartis. Professor Phil Chowienczyk has an interest in Centron Diagnostics, a company that has produced technology for blood pressure measurement. Professor Jacob George has received grants and travel funding from Astra Zeneca, Novartis and Daiichi Sankyo, is on Advisory Boards for AstraZeneca, Menarini and Novartis, consulting fees from Roche and PwC and is a Principal Investigator for studies funded by AstraZeneca, Alnylam, Novartis, Esperion. Dr Pankaj Gupta has received research grants, lecture honoraria and funding for conference attendance from Sanofi-Aventis and Amgen, and consulting fees from Ionis Pharmaceuticals. Professor Anthony Heagerty has received lecture honoraria from Servier. Dr Spoorthy Kulkarni is a PhD student at the University of Cambridge funded by AstraZeneca and has attended scientific advisory boards for Viatris. Professor Terry McCormack has received lecture honoraria and/or consultation fees from AstraZeneca, Daichi-Sankyo, and Medtronic. He is a co-investigator in the Alnylam study Kardia 3. Professor Neil R Poulter has received lecture honoraria and/or consultation fees from several pharmaceutical companies that manufacture blood pressure lowering agents including AstraZeneca, Eva Pharma, Lri Therapharma, Napi, Pfizer, Servier and Sanofi-Aventis. Professor Ian B Wilkinson has received research grants from AstraZeneca, GSK and scientific advisory board consultation fees for Viatris, Astra Zeneca and Roche. Dr Luca Faconti, Dr Carmen Maniero, Dr Vikas Kapil, Dr Philip Lewis, Ms Michaela Nuttall, Mr Sam Olden, Dr Sarah Partridge, Dr Alfredo Petrosino, Dr Abilash Sathyanarayanan, Professor Peter Sever, Dr Wayne Sunman and Dr Helen Warren have no competing interests to declare for this manuscript.

Figures

Fig. 1
Fig. 1. Practical approach to the investigation and management of resistant hypertension.
RH resistant hypertension, BP blood pressure, HBPM home blood pressure monitoring, ABPM ambulatory blood pressure monitoring, DOT directly observed therapy.
Fig. 2
Fig. 2. Procedure for accurate office blood pressure measurement.
AF atrial fibrillation, BP blood pressure.
Fig. 3
Fig. 3. British and Irish Hypertension Society Adult Hypertension Pathway Therapeutic Management. Reproduced from Lewis et.al. J Hum Hypertens. 2024;38 [1]: 3-7 [114] under Creative Commons licence CC BY 4.0: http://creativecommons.org/licences/by/4.0/.
Footnotes to Fig. 3: See Lewis et al. J Hum Hypertens. 2024;38 [1]: 3-7 for footnote explanations [114].
Fig. 4
Fig. 4. Therapeutic management of resistant hypertension.
BP blood pressure, HT hypertension, CKD chronic kidney disease, HF heart failure, T2DM type 2 diabetes mellitus, DOT directly observed therapy.
See this image and copyright information in PMC

References

    1. Global Burden of Disease Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223–49. - PMC - PubMed
    1. NCD Risk Factor Collaboration. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389(10064):37–55. - PMC - PubMed
    1. British Heart Foundation. Cardiovascular Disease Statistics Factsheet UK 2024 2024 [Available from: https://www.bhf.org.uk/-/media/files/for-professionals/research/heart-st....
    1. Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012;125(13):1635–42. - PMC - PubMed
    1. Hung CY, Wang KY, Wu TJ, Hsieh YC, Huang JL, Loh el W, et al. Resistant hypertension, patient characteristics, and risk of stroke. PLoS ONE. 2014;9(8):e104362. - PMC - PubMed

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