Updated Guidelines for Resistant Hypertension

September 13, 2018

The American Heart Association has updated its 2008 guidelines on the detection and management of resistant hypertension.

Resistant hypertension was 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.”

Among the new recommendations:

  • Sleep patterns should be assessed in patients with resistant hypertension, as poor sleep duration and quality can trigger the sympathetic and renin-angiotensin systems, interfering with BP control.
  • Lifestyle changes (sodium intake, weight loss, exercise, and sleep duration) should be emphasized as part of first-line management of resistant hypertension.
  • Consider switching from hydrochlorothiazide to chlorthalidone or indapamide in patients whose hypertension persists despite optimal lifestyle and treatment with a 3-drug regimen.

“It is extremely important to get blood pressure down by whatever means one can, because study after study has shown the negative outcomes from pressures that remain elevated above the target level,” concluded Robert M Carey, MD, chair of the statement writing group and professor of medicine at the University of Virginia Health Sciences Center.

—Michael Potts

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