Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep;3(9):e430.

Refractory Versus Resistant Hypertension: Novel Distinctive Phenotypes

Affiliations
Free PMC article

Refractory Versus Resistant Hypertension: Novel Distinctive Phenotypes

Tanja Dudenbostel et al. J Nat Sci. .
Free PMC article

Abstract

Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed.

Keywords: Aldosterone; antihypertensive treatment failure; sympathetic activity; treatment resistance; volume dependent.

Conflict of interest statement

Conflict of Interest: No conflicts declared.

Figures

Figure 1
Figure 1
Factors associated with refractory hypertension compared with controlled resistant hypertension.

Similar articles

See all similar articles

Cited by 9 articles

See all "Cited by" articles

LinkOut - more resources

Feedback