- 📄 Leopold JA, Ingelfinger JR. Aldosterone and Treatment-Resistant Hypertension. New England Journal of Medicine. 2023;388(5):464-467. doi:10.1056/nejme2213559
- High BP despite concurrent use of three anti-hypertensive agents of different classes, one of which should be a diuretic
- “True” Resistant HTN is defined as “Failure to reach goal BP <130/80 mm Hg while documenting ingestion of three-drug antihypertensive regimen including an appropriate diuretic for kidney function, a CCB and a RAS blocker maximally dosed”
Diagnosis
- All of the following need to be present before diagnosing someone as having TRUE resistant hypertension
- Adherence with: Low Sodium Diet Intake and Medication
- Good Sleep Quality (i.e., minimum of 6-7 hours of uninterrupted sleep a night)
- Substitutions of drugs with greater effect within the Same Class i.e. ARBs and diuretics
- Rule out all Secondary Causes of Hypertension
- Before saying anyone is resistant must rule out the most common secondary cause of hypertension: Primary Hyperaldosteronism (prevalence is high and largely unrecognized)
Management
Figure source: 1
Footnotes
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Carey RM, Calhoun DA, Bakris GL, et al. Resistant hypertension: detection, evaluation, and management: a scientific statement from the american heart association. Hypertension. 2018;72(5). doi:10.1161/HYP.0000000000000084 ↩