Resistant Hypertension and the General Practitioner (Monitoring and Treatment)

Abstract

Chronic kidney disease (CKD) has reached epidemic proportions in the general population. Kidney disease is both a result and a consequence of elevated blood pressure. For this reason, hypertension is prevalent in patients with CKD. Resistant hypertension poses considerable risk in terms of cardiovascular morbidity and mortality. True resistant hypertension should be distinguished from white-coat RH, the most common cause of pseudoresistance, by means of ambulatory or home blood pressure monitoring. After confirming the true nature of the hypertension, general practitioner should address issues of medication nonadherence, salt intake in the diet, drug-induced hypertension, optimal dose, and combination of the antihypertensive regimen in the individual patient. If physical examination and/or basic laboratory test results point to a specific cause of secondary hypertension, this should be evaluated and corrected. Some features are what make CKD patients with RH unique, and these factors should be kept in mind in the management of these patients. Drug dose adjustment according to creatinine clearance, attention to proper use of diuretics, avoidance of spironolactone in patients with moderate to severe renal disease, and inclusion of ACE inhibitors and angiotensin-converting enzyme inhibitors as kidney disease retarding agents in the antihypertensive regimen are just a few to mention. GPs should be in close contact and cooperation with hypertension specialists and nephrologists during that process.