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The Obstinate Refractory and Resistance Hypertension
American Journal of Internal Medicine
Volume 8, Issue 5, September 2020, Pages: 211-214
Received: Apr. 17, 2020; Accepted: Aug. 3, 2020; Published: Aug. 20, 2020
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Raj Kamal Choudhry, JLN Medical College, Aryabhatta University, Bhagalpur, Bihar, India
Amrendra Kumar Singh, JLN Medical College, Aryabhatta University, Bhagalpur, Bihar, India
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Resistant hypertension (RHTN) is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is defined as blood pressure (BP) >140/90 mmHg treated with ≥3 antihypertensive medications, including a diuretic, if tolerated. Refractory hypertension is a novel phenotype of severe antihypertensive treatment failure. The proposed definition for refractory hypertension, i.e. BP >140/90 mmHg with use of ≥5 different antihypertensive medications, including a diuretic and a mineralocorticoid receptor antagonist (MRA) has been applied inconsistently. In comparison to RHTN, refractory hypertension seems to be less prevalent than RHTN. This review focuses on current knowledge about this novel phenotype compared with RHTN including definition, prevalence, mechanisms, characteristics and comorbidities, including cardiovascular risk. In patients with RHTN excess fluid retention is thought to be a common mechanism for the development of RHTN. Recently, evidence has emerged suggesting that refractory hypertension may be more of neurogenic etiology due to increased sympathetic activity as opposed to excess fluid retention. Treatment recommendations for RHTN are generally based on use and intensification of diuretic therapy, especially with the combination of a long-acting thiazide-like diuretic and an MRA. Based on findings from available studies, such an approach does not seem to be a successful strategy to control BP in patients with refractory hypertension and effective sympathetic inhibition in such patients, either with medications and/or device based approaches may be needed.
Aldosterone, Antihypertensive Treatment Failure, Treatment Resistance, Sympathetic Activity, Volume Dependent
To cite this article
Raj Kamal Choudhry, Amrendra Kumar Singh, The Obstinate Refractory and Resistance Hypertension, American Journal of Internal Medicine. Vol. 8, No. 5, 2020, pp. 211-214. doi: 10.11648/j.ajim.20200805.13
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This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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