Resistant hypertension: diagnosis, evaluation, and treatment a clinical consensus statement from the Thai hypertension society
Issued Date
2024-01-01
Resource Type
ISSN
09169636
eISSN
13484214
Scopus ID
2-s2.0-85198713130
Journal Title
Hypertension Research
Rights Holder(s)
SCOPUS
Bibliographic Citation
Hypertension Research (2024)
Suggested Citation
Chattranukulchai P., Roubsanthisuk W., Kunanon S., Kotruchin P., Satirapoj B., Wongpraparut N., Sunthornyothin S., Sukonthasarn A. Resistant hypertension: diagnosis, evaluation, and treatment a clinical consensus statement from the Thai hypertension society. Hypertension Research (2024). doi:10.1038/s41440-024-01785-6 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/99769
Title
Resistant hypertension: diagnosis, evaluation, and treatment a clinical consensus statement from the Thai hypertension society
Corresponding Author(s)
Other Contributor(s)
Abstract
Resistant hypertension (RH) includes hypertensive patients with uncontrolled blood pressure (BP) while receiving ≥3 BP-lowering medications or with controlled BP while receiving ≥4 BP-lowering medications. The exact prevalence of RH is challenging to quantify. However, a reasonable estimate of true RH is around 5% of the hypertensive population. Patients with RH have higher cardiovascular risk as compared with hypertensive patients in general. Standardized office BP measurement, confirmation of medical adherence, search for drug- or substance-induced BP elevation, and ambulatory or home BP monitoring are mandatory to exclude pseudoresistance. Appropriate further investigations, guided by clinical data, should be pursued to exclude possible secondary causes of hypertension. The management of RH includes the intensification of lifestyle interventions and the modification of antihypertensive drug regimens. The essential aspects of lifestyle modification include sodium restriction, body weight control, regular exercise, and healthy sleep. Step-by-step adjustment of the BP-lowering drugs based on the available evidence is proposed. The suitable choice of diuretics according to patients’ renal function is presented. Sacubitril/valsartan can be carefully substituted for the prior renin-angiotensin system blockers, especially in those with heart failure with preserved ejection fraction. If BP remains uncontrolled, device therapy such as renal nerve denervation should be considered. Since device-based treatment is an invasive and costly procedure, it should be used only after careful and appropriate case selection. In real-world practice, the management of RH should be individualized depending on each patient’s characteristics. (Figure presented.)