Resistant hypertension is defined as blood pressure above goal despite treatment with three antihypertensive medications — with complementary mechanisms of action, including a diuretic at maximally tolerated doses — or blood pressure at goal but requiring four or more medications.
When a mineralocorticoid receptor antagonist is not tolerated or contraindicated, add-on agents may be tried: amiloride, a beta-blocker, an alpha-blocker, a central sympatholytic drug, a dual endothelin receptor antagonist, or a direct vasodilator. If blood pressure does not reach the goal of <130/80 mmHg on this regimen, the following next step is considered.
DOI: 10.1161/CIR.0000000000001356
Resistant hypertension is defined as BP above goal despite treatment with 3 antihypertensive medications with complementary mechanisms of action, including a diuretic at maximally tolerated doses or BP at goal but requiring ≥4 medications (Figure 8).
In carefully selected patients with systolic and diastolic hypertension (office SBP 140-180 mm Hg and DBP ≥90 mm Hg) and eGFR ≥40 mL/min/1.73 m² who have resistant hypertension despite optimal treatment, or intolerable side effects to additional antihypertensive drug therapy, renal denervation (RDN) may be reasonable as an adjunct treatment to BP medications and lifestyle modification to reduce BP.
View source ↗