Race and Ethnicity Disparities (M Albert, Section Editor)

Current Cardiovascular Risk Reports

, Volume 7, Issue 5, pp 354-363

First online:

Resistant Hypertension

  • Hemant BoolaniAffiliated withDivision of Cardiovascular Disease, Department of Medicine, Howard University Hospital
  • , Archana SinhaAffiliated withDepartment of Medicine, Howard University Hospital
  • , Otelio RandallAffiliated withDivision of Cardiovascular Disease, Department of Medicine, Howard University HospitalHoward University College of Medicine Email author 

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Abstract

Hypertension affects 25 % of all adults worldwide and is a leading risk factor contributing to 62 % of all strokes and 49 % of all cases of heart disease, leading to an estimated 7.1 million deaths a year; equivalent to 13 % of total worldwide deaths. In spite of therapeutic advances, up to 30 % of hypertensive individuals fail to achieve goal blood pressure even with the use of three antihypertensive medications. Resistant hypertension (RH) is a common clinical problem faced by physicians and the incidence is increasing as the population becomes heavier and older. The diagnosis and treatment of RH, is often accompanied by other risk factors such as obesity, sleep apnea, diabetes and chronic kidney disease is important because of the associated increased end organ damage and the subsequent clinical and social impact. Pseudo resistance, lack of blood pressure control due to poor medication adherence or white coat hypertension must be excluded. A successful treatment of RH requires identification of contributing lifestyle factors and eliminating them including the use of multidrug therapy. A potential genetic causes of RH have not been well studied. African American (black) race and certain other ethnic groups are associated with higher prevalence of RH and also poor response to therapy. Studies on RH are limited, in part because of difficulties in enrolling large groups of patients and patient comorbidity, higher cardiovascular risk and other diseases, e.g. sleep apnea, diabetes and chronic kidney disease that can confound the interpretation of study results. This review provides an overview of RH, and its association with risk factors, various ethnic groups, diagnosis and treatment modalities of RH with special emphasis on the relations of the latter with race/ethnicity.

Keywords

Resistant hypertension Blacks Management modalities