Resistant arterial hypertension

Resistant hypertension is defined as a lack to lower 140 mmHg (systolic blood pressure) and 90 mmHg (diastolic blood pressure) values of ambulatory blood pressure (BP) response using 3 antihypertensive agents of different classes, one of which should be a diuretic in patients fully adherent to antihypertensive therapy. Prevalence of resistant hypertension is ranging from about 5 to 50 % in various cohorts. Initial management requires identification of true treatment resistance by out-of-office BP measurements, assessment of adherence and screening for treatable causes of uncontrolled BP. Recent studies try to indicate possible biomarkers of resistance hypertension. Treatment include lifestyle changes, enhancing treatment adherence and optimization of the doses. An invasive approach to resistant hypertension should be kept for persistently severe cases managed in a specialized hypertension center. This article aims to familiarize readers with the evaluation and management of resistant hypertension by outlining the most recent evidence-based treatment options.