Abstract
Resistant hypertension (RH) is defined as failure to achieve goal blood pressure while
receiving a 3 drug regimen at optimal doses that includes a diuretic. The exact prevalence
of resistant hypertension is unknown which may vary from 5% to 50%. Patient or clinician-related
factors contributing to resistant hypertension include patient’s non-adherence to
antihypertensive therapy, White-coat effect and pseudo-hypertension and life style
factors (Obesity, alcohol, smoking, dietary sodium etc). Several drugs may induce
pre-existing hypertension where non-steroidal anti-inflammatory drugs are usually
the most common due to their frequent use; whereas oral contraceptives, sympathomimetics
(decongestants, anorectics), adrenal steroids and antineoplastic drugs targeting the
vascular endothelial growth factor (VEGF) pathway has a good deal of contribution
to resistant hypertension. Most common secondary causes of resistant hypertension
are obstructive sleep apnea, renal artery stenosis, renal parenchymal disease, and
primary aldosteronism while some uncommon causes such as pheochromocytoma, Cushing’s
disease, thyroid and parathyroid dysfunction; and aortic coarctation also contribute
to resistant hypertension. Both pharmacological and non-pharmacological treatments
are available for the management of resistant hypertension. This article reviews the
prevalence, symptoms, causes and treatment of resistant hypertension.
Key words
antihypertensive therapy - blood pressure - combination therapy - resistant hypertension