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Causes of Resistant Hypertension

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Resistant Hypertension

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Abstract

Resistant arterial hypertension is defined as high blood pressure that cannot be adequately controlled according to the current guidelines (i.e., blood pressure of ≥140/90 mm Hg) despite concurrent use of three or more antihypertensive drugs of different classes, including a diuretic, at their maximum or highest tolerated doses. Resistant hypertension is an increasingly common medical problem, and patients with this condition are at a high risk of cardiovascular events. The prevalence of resistant hypertension is unknown, but data from clinical trials suggest that approximately 10 % of hypertensive individuals may be resistant to antihypertensive treatment. The prevalence of secondary hypertension increases with age, mainly due to increases in the risk of developing chronic kidney disease, obstructive sleep apnea, and renal artery stenosis. Causes of resistant hypertension are non-adherence to drug therapy, suboptimal pharmacologic therapy, poor adherence to lifestyle factors, drug-induced hypertension, renal and endocrine secondary causes of hypertension, obstructive sleep apnea, and rare diseases (e.g., coarctation of the aorta). All patients confirmed to have resistant hypertension should therefore be investigated for these secondary causes and, when possible, referred to an appropriate hypertension specialist. The goal of this chapter is to review the causes of resistant hypertension as reflected in the current literature including guidelines with particular emphasis on recommendations in daily practice.

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  1. Nephrology and Hypertension, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany

    Roland E. Schmieder

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  1. IRCCS Istituto Auxologico Italiano, University of Milano Bicocca, Milan, Italy

    Giuseppe Mancia

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Schmieder, R.E. (2013). Causes of Resistant Hypertension. In: Mancia, G. (eds) Resistant Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-5415-8_7

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