Evaluation and Management of Resistant Hypertension: Core Curriculum 2024.

Autor:	Cluett JL; Division of General Medicine (JLC), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Complex Hypertension Clinic (JLC, JHW), Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts., William JH; Division of Nephrology (JHW), Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Complex Hypertension Clinic (JLC, JHW), Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: jhwillia@bidmc.harvard.edu.
Jazyk:	angličtina
Zdroj:	American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2024 Sep; Vol. 84 (3), pp. 374-387. Date of Electronic Publication: 2024 Jul 20.
DOI:	10.1053/j.ajkd.2024.04.009
Abstrakt:	Resistant hypertension is defined as blood pressure above goal despite confirmed adherence to 3 first-line antihypertensive agents or when blood pressure is controlled with 4 or more medications at maximal or maximally tolerated doses. In addition to meeting these criteria, identifying patients with true resistant hypertension requires both accurate in-office blood pressure measurement as well as excluding white coat effects through out-of-office blood pressure measurements. Patients with resistant hypertension are at higher risk for adverse cardiovascular events and are more likely to have a potentially treatable secondary cause contributing to their hypertension. Effective treatment of resistant hypertension includes ongoing lifestyle modifications and collaboration with patients to detect and address barriers to optimal medication adherence. Pharmacologic treatment should prioritize optimizing first-line, once daily, longer acting medications followed by the stepwise addition of second-, third-, and fourth-line agents as tolerated. Physicians should systematically evaluate for and address any underlying secondary causes. A coordinated, multidisciplinary team approach including clinicians with experience in treating resistant hypertension is essential. New treatment options, including both pharmacologic and device-based therapies, have recently been approved, and more are in the pipeline; their optimal role in the management of resistant hypertension is an area of ongoing research. (Copyright © 2024 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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