How is resistant hypertension (high blood pressure) defined?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Resistant hypertension is defined as uncontrolled blood pressure (BP) (previously ≥140/90 mm Hg; ≥130/90 mm Hg per the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines [1] ) despite treatment with antihypertensive agents of three or more different classes, of which one is a diuretic, [42, 106] or controlled BP on a four-drug regimen. Data suggest that the addition of low-dose spironolactone provides significant additive BP reduction in both black patients and white patients who have resistant hypertension, with or without primary hyperaldosteronism. [107]  However, ambulatory BP is normal in more than one third of patients with resistant hypertension, stressing the importance of monitoring patients to achieve correct diagnosis and management. [108] Patients should also be monitored for medication nonadherence, [106] which has been reported to be as high as 66% in those with resistant hypertension. [109] At-risk patients should also be tested for occult obstructive sleep apnea.


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