Archive \ Volume.10 2019 Issue 3

Evaluation of Recent Updates Regarding the Management of Resistant Hypertension

Mahdi A.Al Muammar, Ibrahim A. Alsubaihi, Mohammed K.S. Alqahtani, Hajar S. Dajam, Omar A. M. Alshanqiti, Naif B. bin Darwish, Almaali M. Alrakha, Reema F. Aloufi, Majid R.H. Alyami, Salman F. Alanazi

Background: Resistant hypertension is believed to affect around 10% of the general hypertensive population. It is a dangerous condition that should not be neglected because it can cause severe target organ damage due to the persistently high blood pressure levels. The treatment of this subgroup must be aggressive and careful in order to control their blood pressure. Objective: This study was aimed to review the recent literature that has discussed resistant hypertension and its management. Methods: PubMed database was used for articles selection and the following keywords were used in the MeSH: resistant hypertension, and management of resistant hypertension. A total number of 50 papers were reviewed and included in the review. Conclusion: Since resistant hypertension is a complex condition, its management is also complicated due to its multifactorial etiology. Treatment depends on the identification of the underlying factors contributing to treatment resistance and reversing them. Choosing effective multi-drug regimens is important and lifestyle changes should be encouraged. Failure of one antihypertensive agent to lower blood pressure to target levels requires the dose to be increased, and/or further antihypertensive medications from these different drug classes to be added up to a maximum of three different drug classes. Aliskiren, which is a direct renin inhibitor, has also been found to be an effective add-on treatment. The addition of spironolactone allows in some patients for adequate control but its use can be limited because of the concerns regarding its potential adverse effects.