A reappraisal of the european guidelines on hypertension management was published in 2009 j hypertens 2009. Pdf resistant hypertension is defined as a lack of ambulatory blood pressure response to optimized medical treatment after exclusion of. Management of patients with diabetes and resistant hypertension. If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which usually should be a diuretic, you may have resistant hypertension. Resistant hypertension rh is defined as abovegoal elevated blood pressure bp in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a longacting calcium channel blocker, a blocker of the reninangiotensin system angiotensinconverting enzyme inhibitor or angiotensin receptor blocker, and a diuretic. Nice guideline draft march 2019 1 of 44 1 national institute for health and care 2 excellence 3 guideline 4 hypertension in adults. Diagnosis and management of resistant hypertension bmj heart. Full text exercise as a tool for hypertension and resistant. Resistant hypertension american board of family medicine.
Resistant hypertension is defined as blood pressure that remains above goal in spite of concurrent use of 3 antihypertensive agents of different classes. James p sheppard,1 una martin,2 richard j mcmanus1. Diagnosis and initial management of obstructive sleep apnea without polysomnography. Important issues include new diagnostic thresholds, outofoffice bp monitoring, intensified treatment goals, and a different approach to resistant hypertension. Considering the growing prevalence of hypertension and the strong link. Guideline for the diagnosis and management of hypertension in adults 2016. Knowledge and management of resistant hypertension rht has matured in recent years with the help of new epidemiological data, wider application of outofoffice bp measurements and the introduction of interventional treatments. Resistant or difficulttocontrol high blood pressure is an entity that differs from the current arterial hypertension because of its difficult management due to more strict criteria in its. The evaluation of resistant hypertension includes confirming blood pressure measurements with an automated device that works without the clinician present and with 24hour ambulatory monitoring. Guideline for the diagnosis and management of hypertension. High blood pressure hypertension is one of the most important risk factors for cardiovascular diseases and is a significant cause of morbidity and mortality worldwide. Next, we highlighted the key points required for the diagnosis of treatment resistant hypertension, including the recording of the ambulatory blood pressure and the assessment of adherence to.
Resistant hypertension is defined in order to identify patients who are at high risk of having reversible causes of hypertension and who may benefit from special diagnostic and therapeutic considerations. Hypertension epidemiology the prevalence of hypertension in u. Patients with resistant hypertension are at high risk. High blood pressure hypertension diagnosis and treatment. Resistant hypertension is a medical problem without a clear solution, since antihypertensive medications and renal denervation the common treatment options to lower blood pressure in these patients have demonstrated reduced efficacy. Resistant hypertension is defined as high blood pressure requiring 3 or more medications for adequate control or controlled blood pressure requiring 4 or more medications.
Diagnosis and management of resistant hypertension american. The first comprehensive guideline for detection, evaluation, and management of high bp was published in 1977, under the sponsorship of the nhlbi. Pdf hypertension resistant to lifestyle interventions and antihypertensive medications is a common problem encountered by physicians in everyday. Clinical diagnosis and management of resistant hypertension ncbi.
Hypertension annals of internal medicine american college. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively. Hypertension diagnosis and management effective date. When hypertension fails to respond to medical treatment there is usually another explanation, such as poor patient compliance, excessive salt ingestion, drug interactions, spuriously high office readings, or an unsuspected secondary cause for the hypertension. The management of patients with resistant hypertension requires a gratifying combination of clinical acumen and common sense. Hypertension guideline resources american heart association. Nov 20, 2012 resistant hypertension is given a modicum of coverage on pages 15067.
Therapy of neonatal hypertension should be tailored to the severity of the blood pressure elevation, and to the underlying cause of hypertension as appropriate. Resistant hypertension is known to have several common risk factors such as african american race, higher body mass index, older age, chronic kidney disease ckd, and diabetes mellitus dm. National heart foundation of australia guideline for the diagnosis and management of hypertension in adults 2016 i acknowledgements national heart foundation of australia national blood pressure and vascular disease advisory committee. Evaluation of possible rh begins with an assessment of adherence to medications. Ideally, one of the 3 agents should be a diuretic and all agents should be prescribed at optimal dose amounts. The acc and aha convened this writing committee to address the prevention, detection, evaluation, and management of high blood pressure in adults. It is intended to assist healthcare providers in all aspects of patient care, including, but not limited to, screening, diagnosis, and management. When a patients systolic and diastolic blood pressure levels fall into different categories, the higher diagnostic category and recommended actions apply. A wide range of therapeutic agents are now available for management of neonatal hypertension in both the acute and chronic settings.
Resistant hypertension rh is defined as blood pressure above a goal despite adherence to at least 3 optimally dosed antihypertensive medications of different classes, one of which is a diuretic. Resistant hypertension is defined as a lack of ambulatory blood pressure response to optimized medical treatment after exclusion of secondary hypertension in patients who are fully adherent to. Diagnosis and management of resistant hypertension. Because hypertension is largely managed with drug therapy, clinical pharmacists often participate in management, especially when hypertension may be difficult to manage because of factors such as adverse effects or resistant hypertension. As defined, resistant hypertension includes patients whose blood. Important issues include new diagnostic thresholds, out of office bp monitoring, intensified treatment goals, and a different approach to resistant hypertension. Considering the growing prevalence of hypertension and the strong link with cardiovascular disease, it is vital to understand the causes and treatment of resistant hypertension. Pdf diagnosis and management of resistant hypertension. Primary care physicians should be aware of the therapeutic approach for hypertension when traditional therapy fails. Knowledge and management of resistant hypertension rht has matured in recent. Results of a randomized controlled pilot trial of intravascular renal denervation for management of treatment resistant hypertension. Jul 18, 2016 reproduced with permission from the national heart foundation of australia.
The goal is to provide a practical reference to assist clinicians with uptodate management of patients with high bp. Diagnosis and management of resistant hypertension hypertension. June 22, 2016 scope this guideline provides recommendations on how to diagnose and manage hypertension htn in adults aged. Resistant hypertension, uncontrolled blood pressure, hypertension, clinical management, diagnosis disclosure. Resistant hypertensionuncontrolled hypertension with 3 or more antihypertensive agentsis increasingly common in clinical practice. Jnc8 guidelines for the management of hypertension in.
This article aims to familiarise readers with the evaluation and management of resistant hypertension by outlining the most recent evidencebased treatment options. Pdf diagnosis and treatment of resistant hypertension. Jun 04, 2014 resistant hypertension uncontrolled hypertension with 3 or more antihypertensive agentsis increasingly common in clinical practice. Resistant hypertension is defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic. At the conclusion of this program, participants will be able to. There is a direct relationship between hypertension and cardiovascular disease cvd. This guideline covers identifying and treating primary hypertension high blood pressure in people aged 18 and over, including people with type 2 diabetes.
Jude medical, and honoraria and travel expenses from medtronic. Outside the scope of this guideline is the management of secondary causes of htn, accelerated htn, acute htn in emergency. The whitecoat effect should be ruled out by out of office blood pressure monitoring. Secondary hypertension is a type of hypertension with an underlying, potentially correctable cause. Resistant hypertension rht is variably defined as insufficient blood pressure bp response to multiple drug treatment. As defined, resistant hypertension includes patients whose blood pressure is controlled with use of. Management of resistant hypertension can be aided by identifying the hemodynamic and.
Discuss the relationship between hypertension, diabetes, and related conditions describe the. Clinical diagnosis and management of resistant hypertension. The whitecoat effect should be ruled out by outofoffice blood pressure monitoring. Pathophysiology and causes of resistant hypertension.
Common secondary causes of resistant hypertension and. Reproduced with permission from the national heart foundation of australia. Apr 02, 20 this masters in medicine webcast is one in a threepart series by dr. Recommendations for the management of patients with resistant hypertension. A scientific statement from the american heart association professional education committee of the council for high blood pressure research. The systemwide goal of evidencebased guidelines is to improve the patients health and wellbeing by guiding health providers.
Hypertension guideline resources uncontrolled high blood pressure bp can lead to heart attack, stroke, heart failure and other serious life threats. Resistant hypertension is given a modicum of coverage on pages 15067. As we enter the third millennium, we are on the verge of the biggest epidemic of cardiovascular disease in human history, most of it blood pressure related 3. A secondary etiology may be suggested by symptoms e. Vadod clinical practice guideline for the diagnosis and. Guideline for the diagnosis and management of hypertension in.
Clinicians should exclude pseudoresistant hypertension, which results from nonadherence to medications or from elevated blood pressure related to. We have since corrected these errors and the correct publishers. Patients whose blood pressure is controlled with four or more medications are considered to have resistant hypertension. Describe the basic epidemiology and importance of hypertension discuss current evidencebased management. This masters in medicine webcast is one in a threepart series by dr.
Resistant hypertension is generally defined as uncontrolled clinic blood pressure 14090 mm hg after treatment with three or more antihypertensives. Clinicians should exclude pseudoresistant hypertension, which results from nonadherence to medications or from elevated blood pressure related to the white coat syndrome. New perspectives in diagnosis and treatment of resistant. An extensive workup of all patients with uncontrolled hypertension is scientifically unsound, is very costly and requires immense human and technical resources. Resistant hypertension, uncontrolled blood pressure, hypertension, clinical management, diagnosis. Diagnosis and management of resistant hypertension heart. Resistant hypertension is defined as a lack of ambulatory blood pressure response to optimized medical treatment after exclusion of secondary hypertension in patients who are fully adherent to antihypertensive therapy. Cpt has received a research grant, honoraria and travel expenses from st. Hypertension, or high blood pressure bp, is defined as a persistent systolic blood pressure sbp greater than or equal to 140 mm hg, diastolic blood pressure dbp greater than or equal to 90 mm hg, or current use of antihypertensive medication. Abstractblood pressure that remains above target levels despite drug therapy is an increasingly common problem. Prevalence of resistant hypertension is increasing.
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