Guillaume Lamirault*, Mathieu Artifoni, Mélanie Daniel, Nicolas Barber-Chamoux and Nantes University Hospital Working Group on Hypertension Pages 61 - 72 ( 12 )
Hypertension is the most common chronic disease and the leading risk factor for disability and premature deaths in the world, accounting for more than 9 million deaths annually. Resistant hypertension is a particularly severe form of hypertension. It was described 50 years ago and since then has been a very active field of research. This review aims at summarizing the most recent findings on resistant hypertension.
The recent concepts of apparent- and true-resistant hypertension have stimulated a more precise definition of resistant hypertension taking into account not only the accuracy of blood pressure measurement and pharmacological class of prescribed drugs but also patient adherence to drugs and life-style recommendations.
Recent epidemiological studies have reported a 10% prevalence of resistant hypertension among hypertensive subjects and demonstrated the high cardiovascular risk of these patients. In addition, these studies identified subgroups of patients with even higher morbidity and mortality risk, probably requiring a more aggressive medical management.
In the meantime, guidelines provided more standardized clinical work-up to identify potentially reversible causes for resistant hypertension such as secondary hypertension. The debate is however still ongoing on which would be the optimal method(s) to screen for non-adherence to hypertension therapy, recognized as the major cause for (pseudo)-resistance to treatment.
Recent randomized clinical trials have demonstrated the strong benefit of anti-aldosterone drugs (mostly spironolocatone) as fourth-line therapies in resistant hypertension whereas clinical trials with device-based therapies displayed contrasting results. New trials with improved devices and more carefully selected patients with resistant hypertension are ongoing.
Hypertension, resistant hypertension, secondary hypertension, blood pressure measurement, antihypertensive drugs, adherence to therapy, medical devices.
l'institut du Thorax, INSERM, CNRS, UNIV Nantes, Nantes, CHU Nantes, Service de Medecine Interne, Nantes, Clinical Pharmacology Centre (INSERM CIC1505), CHU Clermont-Ferrand, Hospices Civils de Lyon, Lyon, CHU Nantes, Nantes