Resistant Hypertension A Review Of Diagnosis And Management Pdf
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- Resistant hypertension: a review of diagnosis and management.
- Resistant hypertension: a review of diagnosis and management
- Diagnosis and management of resistant hypertension: state of the art
Resistant hypertension: a review of diagnosis and management.
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. DOI: Resistant hypertension-uncontrolled hypertension with 3 or more antihypertensive agents-is increasingly common in clinical practice. Clinicians should exclude pseudoresistant hypertension, which results from nonadherence to medications or from elevated blood pressure related to the white coat syndrome. In patients with truly resistant hypertension, thiazide diuretics, particularly chlorthalidone, should be considered as one of the initial agents. View on PubMed.
Resistant hypertension—uncontrolled hypertension with 3 or more antihypertensive agents—is increasingly common in clinical practice. Clinicians should exclude pseudoresistant hypertension, which results from nonadherence to medications or from elevated blood pressure related to the white coat syndrome. In patients with truly resistant hypertension, thiazide diuretics, particularly chlorthalidone, should be considered as one of the initial agents. The other 2 agents should include calcium channel blockers and angiotensin-converting enzyme inhibitors for cardiovascular protection. An increasing body of evidence has suggested benefits of mineralocorticoid receptor antagonists, such as eplerenone and spironolactone, in improving blood pressure control in patients with resistant hypertension, regardless of circulating aldosterone levels. Thus, this class of drugs should be considered for patients whose blood pressure remains elevated after treatment with a 3-drug regimen to maximal or near maximal doses.
In , the American College of Cardiology and American Heart Association released updated guidelines that detail steps to ensure proper diagnosis of RH, including the exclusion of pseudoresistance. Lifestyle modifications, such as low salt diet and physical exercise, remain at the forefront of optimizing blood pressure control. Secondary causes of RH also need to be investigated, including screening for obstructive sleep apnea. Notably, the guidelines demonstrate a major change in medication management recommendations to include mineralocorticoid receptor antagonists. In addition to advances in medication optimization, there are several device-based therapies that have been showing efficacy in the treatment of RH. Renal denervation therapy has struggled to show efficacy for blood pressure control, but with a re-designed catheter device, it is once again being tested in clinical trials. Carotid baroreceptor activation therapy BAT via an implantable pulse generator has been shown to be effective in lowering blood pressure both acutely and in long-term follow up data, but there is some concern about the safety profile.
Resistant hypertension: a review of diagnosis and management
Blood pressure relationship with risk of cardiovascular and renal events. Importance of hypertension-mediated organ damage in refining cardiovascular risk assessment in hypertensive patients. Advantages and disadvantages of ambulatory blood pressure monitoring and home blood pressure monitoring. Clinical indications for out-of-office blood pressure measurements. Using hypertension-mediated organ damage to help stratify risk in hypertensive patients. Hypertension-mediated organ damage regression and cardiovascular risk reduction with antihypertensive treatment. When to refer a patient with hypertension for hospital-based care.
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. It remains the most important modifiable risk factor for coronary heart disease, stroke, congestive heart failure, renal disease, and peripheral vascular disease. Because of the associated morbidity, mortality and economic cost to society early diagnosis and treatment within the established guidelines is imperative.
Thus, this class of drugs should be considered for patients whose blood pressure remains elevated after treatment with a 3-drug regimen to.
Diagnosis and management of resistant hypertension: state of the art
Treatment-resistant hypertension TRH is a well-described condition in adult patients that is associated with poor clinical outcomes. While case reports of hypertension resistant to therapy in children have been published, it is unclear if TRH truly exists in childhood. This educational review will briefly summarize recent evidence and recommendations for TRH in adults, as well as will review the literature regarding medically resistant hypertension in children and adolescents. Finally, we propose a clinical approach for evaluation hypertensive children and adolescents with apparent treatment resistance.
This open-access and indexed, peer-reviewed journal publishes review articles ideal for the busy physician. Dimitris Tousoulis. Resistant hypertension RHT is variably defined as insufficient blood pressure BP response to multiple drug treatment. Initial management of patients with apparent RHT requires identification of true treatment resistance by out-of-office BP measurements, assessment of adherence and screening for treatable causes of uncontrolled BP.
Вы уничтожите этот алгоритм сразу же после того, как мы с ним познакомимся. - Конечно. Так, чтобы не осталось и следа.
- Это. Теперь все в порядке. Сьюзан не могла унять дрожь. - Ком… мандер, - задыхаясь, пробормотала она, сбитая с толку.
Простите, что я на вас накричала. Я так испугалась, увидев. - Не стоит, - удивился Беккер - Я зашел куда не следовало. - Моя просьба покажется вам безумной, - сказала она, заморгав красными глазами, - но не могли бы вы одолжить мне немного денег. Беккер посмотрел на нее в полном недоумении.
Уже два часа утра.