Abstract
Resistant or refractory hypertension is a very complex disease, being characterized by persistently high blood pressure (BP) levels above the recommended BP goals (i.e., below 140/90 mmHg) in the presence of lifestyle changes and optimal antihypertensive strategy based on at least three antihypertensive agents, including a diuretic at adequate doses. As such, this condition is associated with higher risk of cardiovascular morbidity and mortality than essential hypertension and deserves specific pharmacological and non-pharmacological interventions to reduce this risk. Several reasons can be advocated to explain why BP remains persistently high, although it is often quite difficult to identify a specific pathophysiological aspect that may induce and maintain high BP levels despite optimal pharmacological and non-pharmacological therapies. Whatever the case, it is quite evident that these patients need a multidisciplinary and integrated clinical approach to ensure persistence on favorable lifestyle measures, high adherence and compliance to prescribed antihypertensive therapy, and accurate out-of-office (home and ambulatory) BP measurements. In this chapter, we will discuss the potential impact of a multidisciplinary and multidimensional approach for improving BP control in patients with resistant or refractory hypertension and the role of different professional figures involved in the clinical management of hypertension in this high-risk population. We will also briefly address the importance of counseling from trained nurses and the key role of patients’ relatives among non-pharmacologic interventions, which may help to achieve better BP control and improve adherence to prescribed therapy in patients with resistant forms of hypertension.
Conflict of Interest Statement: MV has received research grants from Novartis, has served in international advisory boards of Daiichi Sankyo, Menarini, Malesci, Guidotti, and Novartis Farma, and has lectured in symposia supported by several drug companies producing ARBs and ACE Inhibitors; GT has no conflict of interest to disclose. MV is a member of a Medtronic Global Simplicity Registry; GT has no conflict of interest to disclose.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Staessen JA, Wang J, Bianchi G, Birkenhager WH (2003) Essential hypertension. Lancet 361(9369):1629–1641
Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G et al (2007) ESH–ESC Practice guidelines for the management of arterial hypertension: ESH-ESC task force on the management of arterial hypertension. J Hypertens 25(9):1751–1762
Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F et al (2008) Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ 336(7653):1121–1123
Turnbull F, Neal B, Algert C, Chalmers J, Chapman N, Cutler J et al (2005) Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med 165(12):1410–1419
Turnbull F (2003) Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 362(9395):1527–1535
de Souza F, Muxfeldt E, Fiszman R, Salles G (2010) Efficacy of spironolactone therapy in patients with true resistant hypertension. Hypertension 55(1):147–152
Rodilla E, Costa JA, Perez-Lahiguera F, Baldo E, Gonzalez C, Pascual JM (2009) Spironolactone and doxazosin treatment in patients with resistant hypertension. Rev Esp Cardiol 62(2):158–166
Oparil S, Melino M, Lee J, Fernandez V, Heyrman R (2010) Triple therapy with olmesartan medoxomil, amlodipine besylate, and hydrochlorothiazide in adult patients with hypertension: The TRINITY multicenter, randomized, double-blind, 12-week, parallel-group study. Clin Ther 32(7):1252–1269
Murray AV, Koenig W, Garcia-Puig J, Patel S, Phd AU, Zhang J (2012) Safety and efficacy of aliskiren/amlodipine/hydrochlorothiazide triple combination in patients with moderate to severe hypertension: a 54-week, open-label study. J Clin Hypertens (Greenwich) 14(12):821–827
Kittisupamongkol W (2009) Secondary causes of resistant hypertension. Arch Intern Med 169(7):717
Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K et al (2009) Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 373(9671):1275–1281
Mancia G, Parati G, Zanchetti A (2010) Electrical carotid baroreceptor stimulation in resistant hypertension. Hypertension
Volpe M, Tocci G (2010) Challenging hypertension: how to diagnose and treat resistant hypertension in daily clinical practice. Expert Rev Cardiovascular Ther 8(6):811–820
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr et al (2003) The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 289(19):2560–2572
Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF et al (2004) British hypertension society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ 328(7440):634–640
Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ et al (2009) Reappraisal of European guidelines on hypertension management: a European society of hypertension task force document. J Hypertens 27(11):2121–2158
Volpe M, Erhardt LR, Williams B (2008) Managing cardiovascular risk: the need for change. J Hum Hypertens 22(2):154–157
O’Brien E, Asmar R, Beilin L, Imai Y, Mallion JM, Mancia G et al (2003) European society of hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 21(5):821–848
Cuspidi C, Vaccarella A, Negri F, Sala C (2010) Resistant hypertension and left ventricular hypertrophy: an overview. J Am Soc Hypertens: JASH 4(6):319–324
Klingbeil AU, Schneider M, Martus P, Messerli FH, Schmieder RE (2003) A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 115(1):41–46
Volpe M, Tocci G (2010) Rethinking targets of blood pressure and guidelines for hypertension clinical management. Nephrol Dial Transplant 25(11):3465–3471
Hollenberg NK, Parving HH, Viberti G, Remuzzi G, Ritter S, Zelenkofske S et al (2007) Albuminuria response to very high-dose valsartan in type 2 diabetes mellitus. J Hypertens 25(9):1921–1926
Makino H, Haneda M, Babazono T, Moriya T, Ito S, Iwamoto Y et al (2007) Prevention of transition from incipient to overt nephropathy with telmisartan in patients with type 2 diabetes. Diabetes Care 30(6):1577–1578
Ohishi M, Takagi T, Ito N, Tatara Y, Hayashi N, Shiota A et al (2007) Renal protective effect in hypertensive patients: the high doses of angiotensin II receptor blocker (HARB) study. Hypertens Res 30(12):1187–1192
O’Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T et al (2005) Practice guidelines of the European society of hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens 23(4):697–701
Mancia G, Zanchetti A (1996) White-coat hypertension: misnomers, misconceptions and misunderstandings. What should we do next? J Hypertens 14(9):1049–1052
Elliott WJ (1998) Circadian variation in the timing of stroke onset: a meta-analysis. Stroke 29(5):992–996
Pickering TG, White WB, Giles TD, Black HR, Izzo JL, Materson BJ, et al (2010) When and how to use self (home) and ambulatory blood pressure monitoring. J Am Soc Hypertens: JASH 4(2):56–61
Pimenta E, Calhoun DA, Oparil S (2009) Sleep apnea, aldosterone, and resistant hypertension. Prog Cardiovasc Dis 51(5):371–380
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Italia
About this chapter
Cite this chapter
Volpe, M., Tocci, G. (2013). Involvement of Health Professionals: From the General Practitioner to the Hypertension Specialist and the Hypertension Center. In: Mancia, G. (eds) Resistant Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-5415-8_16
Download citation
DOI: https://doi.org/10.1007/978-88-470-5415-8_16
Published:
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-5414-1
Online ISBN: 978-88-470-5415-8
eBook Packages: MedicineMedicine (R0)