The issue of treatment-resistant hypertension in clinical practice

Resistant hypertension is defined as a clinical situation characterised by a failure to achieve lower systolic and diastolic blood pressure levels below 140 mm Hg and 90 mm Hg, respectively, despite the use of the principles of lifestyle modification as well as pharmacological treatment, including a diuretic as well as two other antihypertensives belonging to different groups, administered at adequate doses (mineralocorticoid receptor may not be included in the regimen). Previous studies suggest that the prevalence of resistant hypertension in the population of patients receiving antihypertensive treatment is 13%. According to a Polish nationwide survey NATPOL 2011, 13% of patients treated due to hypertension suffer from resistant hypertension. It was noted that factors predisposing and/or related to the development of resistant hypertension primarily include: advanced age, high/increased baseline blood pressure (systolic pressure in particular), obesity, excessive salt intake, chronic renal disease and diabetes. There is a consistent view that apart from non-compliance with lifestyle modification, an inadequate antihypertensive regimen and/or non-compliance with therapeutic indications are among the most common causes of treatment-resistant hypertension. Current recommendations for the management of patients with resistant hypertension also stress the importance of identifying the causes of secondary hypertension. This represents a very important element in the management of resistant hypertension and may facilitate pharmacological treatment. In the case of failure to achieve blood pressure target values, it is recommended to include a drug belonging to aldosterone receptor antagonists. If both, non-pharmacological and pharmacological therapies prove inefficient, surgical treatment of resistant hypertension may be considered in selected cases.