Current Hypertension Reports

, Volume 11, Issue 5, pp 323–328 | Cite as

Hypertension: Issues in control and resistance

  • Marion R. Wofford
  • Deborah S. Minor


Hypertension remains uncontrolled in more than 50% of treated patients. Barriers to hypertension control include those that are patient-related, physician-related, and related to the health system. Identification of uncontrolled hypertension, pseudoresistant hypertension, and resistant hypertension require thoughtful attention to accurate blood pressure measurement, lifestyle factors, evaluation for secondary causes of hypertension, and proper treatment. Recent guidelines emphasize the importance of aggressive treatment and referral to hypertension specialists for patients with resistant hypertension, defined as blood pressure that remains above goal despite the use of three appropriate anti hypertensive agents.


Chronic Kidney Disease Obstructive Sleep Apnea Aldosterone Blood Pressure Control Telmisartan 
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References and Recommended Reading

  1. 1.
    Ong KL, Cheung BM, Man YB, et al.: Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension 2007; 49:69–75.PubMedCrossRefGoogle Scholar
  2. 2.
    Chobanian AV, Bakris GL, Black HR, et al.: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC report. JAMA 2003, 289:2560–2572.PubMedCrossRefGoogle Scholar
  3. 3.
    American Heart Association: Heart disease and stroke statistics—2009 update. Circulation 2009, 119:e21–e181.CrossRefGoogle Scholar
  4. 4.
    Franco OH, Peeters A, Bonneux L, de Laet C: Blood pressure in adulthood and life expectancy with cardiovascular disease in men and women: life course analysis. Hypertension 2005, 46:261–262.CrossRefGoogle Scholar
  5. 5.
    Ezzati M, Lopez AD, Rodgers A, et al.: Selected major risk factors and global and regional burden of disease. Lancet 2002, 360:1347–1360.PubMedCrossRefGoogle Scholar
  6. 6.
    Calhoun DA, Jones DA, Textor S, et al.: Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Assoc iation Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008, 51:1403–1419.PubMedCrossRefGoogle Scholar
  7. 7.
    Lloyd-Jones DM, Evans JC, Larson MG, et al.: Differential control of systolic and diastolic blood pressure: factors associated with lack of blood pressure control in the community. Hypertension 2000, 36:594–599.PubMedGoogle Scholar
  8. 8.
    The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002, 288:2981–2997.CrossRefGoogle Scholar
  9. 9.
    Sarafidis PA, Bakris, GL: Resistant hypertension. J Am Coll Cardiol 2008, 52:1749–1757.PubMedCrossRefGoogle Scholar
  10. 10.
    Pickering TG, White WB, American Society of Hypertension Writing Group: ASH Position Paper: home and ambulatory blood pressure monitoring. When and how to use self (home) and ambulatory blood pressure monitoring. J Clin Hypertens (Greenwich) 2008, 10:850–855.CrossRefGoogle Scholar
  11. 11.
    Pickering TG, Shimbo D, Hass D: Ambulatory blood-pressure monitoring. N Engl J Med 2006, 354:2368–2374.PubMedCrossRefGoogle Scholar
  12. 12.
    Ogedegbe G: Barriers to optimal hypertension control. J Clin Hypertens (Greenwich) 2008, 10:644–646.CrossRefGoogle Scholar
  13. 13.
    Minor DS, Wofford MR, Jones DW: Racial and ethnic differences in hypertension. Curr Atheroscler Rep 2008, 10:121–127.PubMedCrossRefGoogle Scholar
  14. 14.
    Garrison RJ, Kannel WB, Stokes J 3rd, Castelli WP: Incidence and precursors of hypertension in young adults; the Framingham Offspring Study. Prev Med 1987, 16:235–251.PubMedCrossRefGoogle Scholar
  15. 15.
    Poirier P, Giles TD, Bray GA, et al.: Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Circulation 2006, 113:898–918.PubMedCrossRefGoogle Scholar
  16. 16.
    Wofford MR, Hall JE: Pathophysiology and treatment of obesity hypertension. Curr Pharm Des 2004, 10:3621–3637.PubMedCrossRefGoogle Scholar
  17. 17.
    Appel LJ, Brands MW, Daniels SR, et al.: Dietary approaches to prevent and treat hypertension: a scientific statement for the American Heart Association. Hypertension 2006, 47:296–308.PubMedCrossRefGoogle Scholar
  18. 18.
    Moser M, Setaro JF: Resistant or difficult to control hypertension. N Engl J Med 2006, 355:355–385.CrossRefGoogle Scholar
  19. 19.
    Sowers JR, Whaley-Connell A, Epstein M: The emerging clinical implications of the role of aldosterone in the metabolic syndrome and resistant hypertension. Ann Intern Med 2009, 150:776–783.PubMedGoogle Scholar
  20. 20.
    Calhoun DA, Nishizaka MK, Zaman MA, et al.: Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension 2002, 40:892–896.PubMedCrossRefGoogle Scholar
  21. 21.
    Pimenta E, Gaddam KK, Oparil S: Mechanisms and treatments of resistant hypertension. J Clin Hypertens (Greenwich) 2008, 10:239–244.CrossRefGoogle Scholar
  22. 22.
    Gaddam KK, Nishizaka MK, Pratt-Ubunama MN, et al.: Characterization of resistant hypertension. Arch Intern Med 2008, 168:1159–1164.PubMedCrossRefGoogle Scholar
  23. 23.
    Logan AC, Perlikowski SM, Mente A, et al.: High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001, 19:1–7.CrossRefGoogle Scholar
  24. 24.
    Pratt-Ubanama MN, Nishizaka MK, Boedefeld MD, et al.: Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension. Chest 2007, 131:453–459.CrossRefGoogle Scholar
  25. 25.
    Goodfriend TL, Calhoun DA: Resistant hypertension, obesity, and aldosterone. Theory and therapy. Hypertension 2004, 43:518–524.PubMedCrossRefGoogle Scholar
  26. 26.
    Mann JF, Schmieder RE, McQueen M, et al.: Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 2008, 372:547–553.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Department of Medicine, Division of General Internal Medicine/HypertensionUniversity of Mississippi Medical CenterJacksonUSA

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