New Support for Old Medications in Resistant Hypertension
The term resistant hypertension has been variably applied to patients with high blood pressure (BP) since at least the 1960s. Specific definitions have evolved over time to align with advances in treatment and BP goals. In 2018, the American Heart Association updated its definition of resistant hypertension as uncontrolled BP levels (≥130/80 mm Hg) despite use of 3 different medication classes (typically a calcium channel blocker, renin-angiotensin system inhibitor, and diuretic) at maximal (or maximally tolerated) doses. Patients taking 4 or more medications regardless of BP control are also included in the definition. Determining true resistant hypertension requires the exclusion of white-coat hypertension (ie, uncontrolled clinic-measured BP, with either home or ambulatory readings at goal) and medication nonadherence. Resistant hypertension is a complex multifactorial condition, and it must be acknowledged that basing its definition on a specific BP threshold and number of drugs is inherently subjective in some regards.
The term resistant hypertension has been variably applied to patients with high blood pressure (BP) since at least the 1960s. Specific definitions have evolved over time to align with advances in treatment and BP goals. In 2018, the American Heart Association updated its definition of resistant hypertension as uncontrolled BP levels (≥130/80 mm Hg) despite use of 3 different medication classes (typically a calcium channel blocker, renin-angiotensin system inhibitor, and diuretic) at maximal (or maximally tolerated) doses. Patients taking 4 or more medications regardless of BP control are also included in the definition. Determining true resistant hypertension requires the exclusion of white-coat hypertension (ie, uncontrolled clinic-measured BP, with either home or ambulatory readings at goal) and medication nonadherence. Resistant hypertension is a complex multifactorial condition, and it must be acknowledged that basing its definition on a specific BP threshold and number of drugs is inherently subjective in some regards.
