Diagnosis and management of resistant hypertension: state of the art.
Resistant hypertension is defined as a lack of ambulatory blood pressure response to optimized medical treatment after exclusion of secondary hypertension in patients who are fully adherent to antihypertensive therapy. Patients with resistant hypertension are at high risk of complications, particula...
| Publicado en: | Nature Reviews Nephrology Vol. 14; no. 7; pp. 428 - 442 |
|---|---|
| Autores principales: | , , , |
| Formato: | research Journal Article |
| Publicado: |
Springer Nature
Jul2018
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=131021985&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 131021985 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 17595061 8UU5 jtl: Nature Reviews Nephrology issn: 17595061 maglogo: N pubinfo: dt: Jul2018 vid: 14 iid: 7 pid: 2579 pub: Springer Nature place: Dordrecht, <Blank> artinfo: ui: 131021985 131021985 NLM29700488 131021985 10.1038/s41581-018-0006-6 NLM29700488 131021985 ppf: 428 ppct: 14 formats: tig: atl: Diagnosis and management of resistant hypertension: state of the art. aug: au: Wei, Fang-Fei Zhang, Zhen-Yu Huang, Qi-Fang Staessen, Jan A. affil: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium sug: subj: Electrotherapy Methods Hypertension Diagnosis Coronary Vasospasm Therapy Antihypertensive Agents Therapeutic Use Hypertension Therapy Sympathectomy Pressoreceptors Coronary Vasospasm Diagnosis Renal Artery Innervation Heterocyclic Compounds Therapeutic Use Renal Artery Surgery Blood Pressure Determination Hypertension Epidemiology Arteriovenous Shunt, Surgical Spironolactone Therapeutic Use Aldosterone Antagonists Therapeutic Use Animal Studies Coronary Vasospasm Epidemiology Carotid Arteries Baroreflex Physiology Human Medication Compliance Carotid Body Surgery Sodium Channel Blockers Therapeutic Use Scales ab: Resistant hypertension is defined as a lack of ambulatory blood pressure response to optimized medical treatment after exclusion of secondary hypertension in patients who are fully adherent to antihypertensive therapy. Patients with resistant hypertension are at high risk of complications, particularly cardiovascular events, and optimization of medical treatment remains the cornerstone of their management. Such optimization should be based on simple algorithms and include the use of aldosterone antagonists. The available data from clinical trials do not support the use of device-based approaches such as renal denervation, baroreflex activation therapy or arteriovenous anastomosis for the treatment of resistant hypertension in the majority of patients. Therefore, device treatment remains a last-resort for patients with truly resistant hypertension in the context of clinical research in highly skilled tertiary referral centres. Future research should focus on improving understanding of the intrinsic (physiological and psychological factors) and extrinsic (environmental stressors) mechanisms that contribute to a lack of response to blood-pressure-lowering drugs in adherent patients. The use of biomarkers to identify patients with early target organ damage and new technologies, such as renal nerve stimulation, to predict blood pressure responses to renal denervation could aid the selection of patients who might benefit from device therapies. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|