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Public Health Efforts for Earlier Resistant Hypertension Diagnosis, Reduction of Salt Content in Food, Promotion of the Use of Polypills to Facilitate Better Adherence, and Reimbursement Policies

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Resistant Hypertension in Chronic Kidney Disease

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Abstract

Resistant hypertension (RHT) is a clinical state in which despite concomitant intake of at least three antihypertensive drugs, one of these preferably being a diuretic at full doses, blood pressure remains uncontrolled. Firstly, it should be confirmed that the patients with resistant hypertension do have true RHT; this can be done by ruling out or correcting factors associated with pseudo-resistance which contain an inaccurate measurement of blood pressure (BP), inappropriate drug choices or doses, and the nonadherence to prescribed therapy or the white-coat effect. The complexity of the treatment regimen, socioeconomic status, lifestyle, and psychological influences affect adherence to medication.

As the popularity of RHT is supposed to increase, effective treatments to enhance results among individuals with RHT are required. Preliminary evidence puts forward that lifestyle changes may be effective in diminishing BP in RHT patients. Reducing dosage demands is defined as the most effective single approach to improve adherence. Reducing dosing can be provided by the use of a fixed-dose combination (FDC) polypill consisting of the recommended treatments in a single daily capsule. This approach has improved adherence and reduced costs.

Treatment methods being researched for the management of RHT contain invasive, irreversible procedures or implantable devices such as renal denervation and carotid baroreceptor stimulation.

It is unclear whether renal denervation may benefit a subset of patients with resistant hypertension. For this reason, the best choice for treatment of RHT appears to be providing well adherence to medication and lifestyle change of patients with RHT.

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Authors and Affiliations

  1. Department of Cardiology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey

    Nursen Keles M.D. & Yusuf Yilmaz M.D.

  2. Department of Cardiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey

    Mustafa Caliskan Prof

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  1. Nursen Keles M.D.
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  2. Yusuf Yilmaz M.D.
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  1. Grigore T. Popa University of Medicine, Iaşi, Romania

    Adrian Covic

  2. Department of Medicine, Division of Nephrology, University School of Medicine, Istanbul, Turkey

    Mehmet Kanbay

  3. Section of Nephrology, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Oak Lawn, Illinois, USA

    Edgar V. Lerma

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Keles, N., Yilmaz, Y., Caliskan, M. (2017). Public Health Efforts for Earlier Resistant Hypertension Diagnosis, Reduction of Salt Content in Food, Promotion of the Use of Polypills to Facilitate Better Adherence, and Reimbursement Policies. In: Covic, A., Kanbay, M., Lerma, E. (eds) Resistant Hypertension in Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-56827-0_15

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