Resistant Hypertension An Update of Experimental and Clinical Findings

Resistant hypertension remains a strong focus of both experimental and clinical research. Recent studies indicate that patients with resistant hypertension, particularly in the setting of CKD, have a worse prognosis than patients with more easily controlled hypertension. Apparent versus true resistant hypertension is an important clinical distinction, with the former often being attributable to pseudocauses of treatment resistance. Important study results indicate that poor adherence and undertreatment likely represent the 2 most common causes of lack of BP control versus true treatment resistance. From a treatment perspective, rigorous clinical trials have firmly established spironolactone as the most appropriate fourth agent for treating resistant hypertension. In regards to device-based therapies, experimental and translational studies suggest that RND will not likely be a universal solution for resistant hypertension. Recent study findings indicate that the presence of accessory arteries that cannot be ac essed by ablation catheters may preclude adequate RND, thereby, minimizing benefit, while reinnervation of kidneys may be an important mediator of duration of antihypertensive benefit. Finally, initial studies of refractory hypertension, an extreme phenotype of antihypertensive failure, suggest that it is rare, but may represent a unique phenotype distinct from resistant hypertension in general by having a neurogenic pathogenesis as opposed to being volume dependent. © 2017 American Heart Association, Inc.