TY - JOUR
T1 - Resistant hypertension
T2 - Detection, evaluation, and management a scientific statement from the American Heart Association
AU - American Heart Association Professional/PublicEducation and Publications Committee of the Council on Hypertension
AU - Council on Cardiovascular and Stroke Nursing
AU - Council on Clinical Cardiology
AU - Council on Genomic
AU - Precision Medicine; Council on Peripheral Vascular Disease
AU - Council on Quality of Care and Outcomes Research
AU - Stroke Council
AU - Carey, Robert M.
AU - Calhoun, David A.
AU - Bakris, George L.
AU - Brook, Robert D.
AU - Daugherty, Stacie L.
AU - Dennison-Himmelfarb, Cheryl R.
AU - Egan, Brent M.
AU - Flack, John M.
AU - Gidding, Samuel S.
AU - Judd, Eric
AU - Lackland, Daniel T.
AU - Laffer, Cheryl L.
AU - Newton-Cheh, Christopher
AU - Smith, Steven M.
AU - Taler, Sandra J.
AU - Textor, Stephen C.
AU - Turan, Tanya N.
AU - White, William B.
N1 - Publisher Copyright:
© 2018 American Heart Association, Inc.
PY - 2018/11
Y1 - 2018/11
N2 - Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the “white-coat effect” (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
AB - Resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic. The antihypertensive drugs should be administered at maximum or maximally tolerated daily doses. RH also includes patients whose BP achieves target values on ≥4 antihypertensive medications. The diagnosis of RH requires assurance of antihypertensive medication adherence and exclusion of the “white-coat effect” (office BP above goal but out-of-office BP at or below target). The importance of RH is underscored by the associated risk of adverse outcomes compared with non-RH. This article is an updated American Heart Association scientific statement on the detection, evaluation, and management of RH. Once antihypertensive medication adherence is confirmed and out-of-office BP recordings exclude a white-coat effect, evaluation includes identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. Management of RH includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone), and, if BP remains elevated, stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP. If BP remains uncontrolled, referral to a hypertension specialist is advised.
KW - AHA Scientific Statements
KW - Antihypertensive agents
KW - Hypertension
KW - Hypertension resistant to conventional therapy
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U2 - 10.1161/HYP.0000000000000084
DO - 10.1161/HYP.0000000000000084
M3 - Article
C2 - 30354828
AN - SCOPUS:85055601008
SN - 0194-911X
VL - 72
SP - E53-E90
JO - Hypertension
JF - Hypertension
IS - 5
ER -