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Resistant hypertension: who and how to evaluate

Acelajado, Maria Czarina; Calhoun, David A

Current Opinion in Cardiology: July 2009 - Volume 24 - Issue 4 - p 340–344
doi: 10.1097/HCO.0b013e32832bc6b5
Hypertension: Edited by William J. Elliott
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Purpose of review Resistant hypertension is found in an important and rapidly growing subset of the hypertensive population, and data characterizing this group of patients are limited. The purpose of this review is to present the latest evidence on resistant hypertension, its risk factors, patient characteristics, and approach to diagnosis. We focus on important associations between resistant hypertension and primary aldosteronism and with obstructive sleep apnea.

Recent findings Resistant hypertension comprises 20–35% of the general hypertensive population. It is important to ascertain that a patient has true resistant hypertension and not merely uncontrolled hypertension. Twenty-four-hour ambulatory blood pressure monitoring can reliably rule out a white-coat effect and may have prognostic significance in patients with resistant hypertension. Patients should be screened for secondary causes of hypertension. Primary aldosteronism is common among patients with resistant hypertension, as is obstructive sleep apnea. A plasma aldosterone to renin ratio is a useful screening tool for primary aldosteronism. Aldosterone has been found to accelerate the increase in left ventricular mass in patients with hypertension.

Summary Patients with resistant hypertension comprise a unique subset, with risk factors and associations that are distinct or pronounced compared with the general hypertensive population. It is important to bear these associations in mind when dealing with patients with true resistant hypertension.

Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, Alabama, USA

Correspondence to Maria Czarina Acelajado, MD, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, CH19 Room 115, 1530 3rd Avenue South, Birmingham, AL 35294-2041, USA Tel: +1 205 934 9281; fax: +1 205 934 1302; e-mail: czarina.acelajado@ccc.uab.edu

© 2009 Lippincott Williams & Wilkins, Inc.