Adult Patient with Resistant Hypertension Secondary to Comorbidities
This clinical case describes the workup and the subsequent treatment changes in a patient referred for resistant hypertension to a Blood Pressure Clinic. Lifestyle was certainly not optimal in this obese patient. Obesity and overweight are quite common in patients with BP elevation, being present in about 75 % of the hypertensive patients seen by general practitioners or specialists. Together with combination treatment with antihypertensive drugs, lifestyle changes represent the most effective strategy for reaching BP control in this group of patients, in whom limitation (and, if possible, complete cessation) of alcohol intake, limitation of dietary salt and increase in physical activity are particularly effective in reducing blood pressure values. When target blood pressure is not reached despite the aforementioned measures, after exclusion of sleep apnoea (which may significantly contribute to treatment resistance), mineralocorticoid receptor antagonists may be considered as third-line drugs in these patients, due to the possible role of increased aldosterone levels in the pathogenesis of resistance to treatment.
KeywordsAmbulatory Blood Pressure Monitoring Resistant Hypertension Normal Heart Rate Home Blood Pressure Mineralocorticoid Receptor Antagonist
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