open access

Vol 76, No 7 (2018)
Reviews
Published online: 2018-06-06
Submitted: 2018-06-06
Accepted: 2018-06-06
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Resistant hypertension

Fang-Fei Wei, Zhen-Yu Zhang, Qi-Fang Huang, Wen-Yi Yang, Jan A. Staessen
DOI: 10.5603/KP.a2018.0129
·
Kardiol Pol 2018;76(7):1031-1042.

open access

Vol 76, No 7 (2018)
Reviews
Published online: 2018-06-06
Submitted: 2018-06-06
Accepted: 2018-06-06

Abstract

The publication of the first non-randomised proof-of-concept trial of renal denervation as a treatment modality in treatment- -resistant hypertension set the stage for a search for novel devices with the expectation that technology would reduce the burden of hypertension by reducing or eliminating the costly and lifelong use of blood pressure-lowering medications. As we demonstrate in this review, this idea was so attractive to manufacturers and invasive cardiologists and radiologists that they overlooked decades of careful pathophysiological research in a disease that remains enigmatic but is still a major cause of cardio­vascular mortality worldwide. To make our point, we first reviewed the prevalence and risks associated with treatment-resistant hypertension. Next, we highlighted the key points required for the diagnosis of treatment-resistant hypertension, including the recording of ambulatory blood pressure and the assessment of adherence to medication. Finally, we summarised new insights in the management of treatment-resistant hypertension by medication and devices as well as in future research. Throughout our review, we focused on new evidence that had become available since 2013. Our conclusion is that optimising medical treatment based on simple algorithms remains the state of the art in treatment-resistant hypertension.

Abstract

The publication of the first non-randomised proof-of-concept trial of renal denervation as a treatment modality in treatment- -resistant hypertension set the stage for a search for novel devices with the expectation that technology would reduce the burden of hypertension by reducing or eliminating the costly and lifelong use of blood pressure-lowering medications. As we demonstrate in this review, this idea was so attractive to manufacturers and invasive cardiologists and radiologists that they overlooked decades of careful pathophysiological research in a disease that remains enigmatic but is still a major cause of cardio­vascular mortality worldwide. To make our point, we first reviewed the prevalence and risks associated with treatment-resistant hypertension. Next, we highlighted the key points required for the diagnosis of treatment-resistant hypertension, including the recording of ambulatory blood pressure and the assessment of adherence to medication. Finally, we summarised new insights in the management of treatment-resistant hypertension by medication and devices as well as in future research. Throughout our review, we focused on new evidence that had become available since 2013. Our conclusion is that optimising medical treatment based on simple algorithms remains the state of the art in treatment-resistant hypertension.

Get Citation

Keywords

resistant hypertension, pharmacology, sympathetic nervous system, baroreflex, renal denervation

About this article
Title

Resistant hypertension

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 76, No 7 (2018)

Pages

1031-1042

Published online

2018-06-06

DOI

10.5603/KP.a2018.0129

Bibliographic record

Kardiol Pol 2018;76(7):1031-1042.

Keywords

resistant hypertension
pharmacology
sympathetic nervous system
baroreflex
renal denervation

Authors

Fang-Fei Wei
Zhen-Yu Zhang
Qi-Fang Huang
Wen-Yi Yang
Jan A. Staessen

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