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Resistant hypertension in 2014, ESC and the European Society of Hypertension

ESC Congress Report

  • Improve the definition of resistant hypertension (RH).
  • Improve clinical assessment of patients with apparent resistant hypertension.
  • Exclude white coat effect, inappropriate drug combinations, compliance to treatment and secondary causes of hypertension.
  • Renal denervation should be restricted to true resistant hypertensive patients.

View the Slides from this session in ESC Congress 365

The session addressed unmet needs in resistant hypertension (RH) and issues that need to be clarified by future research, including aspects related to the definition, prevalence and accurate diagnosis of this condition; how to use the best antihypertensive drug strategy, and the role of interventional therapy, such as renal denervation, in the treatment of these patients.

The main concern about the current definition is related to the inclusion of all patients whose BP is uncontrolled despite the use of 3 antihypertensive drugs (one of them a thiazide diuretic), when we know that more than 3 pathogenetic mechanisms are involved. The question is: why not 4 or 5 drugs at optimal doses, including a diuretic?

The second presentation was devoted to the secondary forms of hypertension, particularly obstructive sleep apnoea syndrome and primary aldosteronism, the most frequent forms associated to resistant hypertension which have to be screened in RH. One of the most important issues is how to select the best treatment strategy combining antihypertensive drugs to normalize BP, and how to be sure that the patient is really taking the prescribed medications.

Several studies in which all prescribed drugs were measured in blood or urine samples found that around 50% of all patients with RH are not taking all the prescribed medication, which is causing complications.  How to improve compliance without “offending” our patients when showing them the results of  tests demonstrating that they are “lying” is a challenge in clinical practice.

Finally, the latest results on the effects of renal denervation in these patients showing no different effects compared to placebo (sham operated) indicates that only patients with true resistant HT should be candidates for the procedure, and this technique must be performed by experts. These unmet needs must be approached in future clinical trials.




Resistant hypertension in 2014, ESC and the European Society of Hypertension

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.