Treatment of resistant hypertension

Minerva Cardioangiol. 2009 Dec;57(6):787-812.


Aim: Resistant hypertension (RH) is a common clinical problem. Patients with RH have increased cardiovascular risk. These patients also have high risk for having reversible causes of hypertension and may potentially benefit from special diagnostic or therapeutic considerations. The purpose of this review was to discuss RH, its definition, recognition, evaluation and treatment.

Methods: Authors define RH and the implications of this definition. They present latest data on its prevalence, prognostic implications, genetics, and patient characteristics. Elements of pseudoresistance and possible etiologies of treatment resistance are also identified. Lastly, diagnostic and therapeutic approaches to RH are discussed, focusing on antihypertensive medication classes that have proven benefit in patients with RH, and also on novel therapeutic approaches in these patients.

Conclusion: RH is a common clinical problem and carries an increased risk for cardiovascular morbidity and mortality, as well as target organ damage. Patients with RH are aat high risk for reversible causes of hypertension and may benefit from special diagnostic or therapeutic considerations. Elements of pseudoresistance, intake of interfering substances and secondary causes of hypertension should be searched for and corrected, if possible. Therapeutic lifestyle modifications should be emphasized. Medical therapy includes optimizing diuretic use and considering the use of mineralocorticoid antagonists as add on antihypertensive agents. Novel approaches include surgical and transcatheter techniques, chronotherapy, and new classes of antihypertensive agents.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Adrenal Gland Neoplasms / complications
  • Adult
  • African Americans
  • Aged
  • Ambulatory Care
  • Antihypertensive Agents / administration & dosage
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure Monitoring, Ambulatory
  • Cardiovascular Diseases / epidemiology*
  • Chlorthalidone / administration & dosage
  • Chlorthalidone / therapeutic use
  • Clinical Trials as Topic
  • Diuretics / administration & dosage
  • Diuretics / therapeutic use
  • Drug Resistance
  • Drug Therapy, Combination
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperaldosteronism / complications
  • Hypertension / diagnosis
  • Hypertension / drug therapy
  • Hypertension / epidemiology
  • Hypertension / genetics
  • Hypertension / therapy*
  • Life Style
  • Male
  • Medication Adherence
  • Obesity / complications*
  • Pheochromocytoma / complications
  • Practice Guidelines as Topic
  • Prevalence
  • Prognosis
  • Renal Artery Obstruction / complications
  • Risk Factors
  • Sleep Apnea, Obstructive / complications
  • Sodium Chloride Symporter Inhibitors / administration & dosage
  • Sodium Chloride Symporter Inhibitors / therapeutic use
  • Time Factors
  • United States / epidemiology


  • Antihypertensive Agents
  • Diuretics
  • Sodium Chloride Symporter Inhibitors
  • Chlorthalidone