Abstract
Notwithstanding the availability of many agents to lower blood pressure (BP), drug-resistant hypertension is re-emerging as an important cause of cardiovascular (CV) events. Neurohumoral factors contribute substantively to the resistance of high BP to treatment, but they are extremely difficult to identify because of the confounding effect of the concomitant antihypertensive treatment. Compelling evidences are also accumulating that renal artery obstruction(s), which can lead to activation of the renin–angiotensin system, and primary aldosteronism (PA) are common causes for resistance of high BP to treatment. Unfortunately, both conditions are markedly under diagnosed, because they often mimic essential (primary) hypertension. For patients affected by these and other treatable diseases, neurohumoral activation has ominous consequences not only because it can translate in resistance to antihypertensive treatment, but also because it exposes the patients to prominent CV damage and an excess rate of CV events. Thus, a timely diagnosis and a specific treatment of the conditions that can cause RH are key for achieving control of high BP and prevention of CV events. As the antihypertensive treatment cannot be stopped and many antihypertensive agents confound the workup, this chapter will review the main neurohumoral factors underlying RH and will address the special problems that the diagnosis poses in patients with RH.
There is no conflict of interest and no financial disclosure concerning this chapter to be disclosed.
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Acknowledgment
The studies reported in this chapter were mostly supported by research grants from The FOundation for advanced Research In Hypertension and CArdiovascular diseases (FORICA), The Società Italiana dell’Ipertensione Arteriosa, The Italian Ministry of University and Scientific Research (MIUR), and The University of Padua.
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Rossi, G.P. (2013). Resistant Hypertension: Neurohumoral Aspects. In: Mancia, G. (eds) Resistant Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-5415-8_2
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DOI: https://doi.org/10.1007/978-88-470-5415-8_2
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