Controlled Versus Uncontrolled Resistant Hypertension: Are They in the Same Bag?

  • J. C. Yugar-Toledo
  • V. Brunelli
  • J. F. Vilela-Martin
  • A. Fattori
  • H. Moreno
Resistant Hypertension (L Drager, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Resistant Hypertension


Purpose of Review

Resistant hypertension (RHTN) is a condition in which besides the antihypertensive therapy using at least three different drugs (including a diuretics), brachial blood pressure does not reach the target (e.g., 140/90 mmHg).

Recent Findings

Despite the diversity of clinical presentations, we divide RHTN in two major groups according to blood pressure and number of drugs taken: controlled (C-RHTN) and uncontrolled (UC-RHTN) resistant hypertension, with refractory hypertension (RfHTN) included in the latter subgroup.

Both C-RHTN and UC-RHTN are heterogenic and complex syndromes. To better approach this matter, the some pathophysiological mechanisms (increased volemia, hyperactivity, plasma cortisol, adipocitokines, and other pro-inflammatory factors), have a pivotal clinical role.

Some features (African ethnic, obesity, age > 60, LV hypertrophy, and vascular stiffness) increase the risk of refractoriness as well as worst prognosis. Based on increased target organ damage, cardiovascular risk and events will be addressed in this review.


Our conclusion is that although both C-RHTN and UC-RHTN are extreme phenotypes of hard-to-control BP, some mechanisms of the disease and clinical expressions are distinct. According to these differences, “UC-RHTN and C-RHTN are not in the same bag.”


Resistant hypertension RHTN Controlled hypertension C-RHTN Uncontrolled resistant hypertension UC-RHTN Refractory hypertension RfHTN 


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • J. C. Yugar-Toledo
    • 1
  • V. Brunelli
    • 2
  • J. F. Vilela-Martin
    • 1
  • A. Fattori
    • 2
  • H. Moreno
    • 2
  1. 1.State Medical School of São José do Rio Preto (FAMERP),São José do Rio PretoBrazil
  2. 2.State University of Campinas (UNICAMP)CampinasBrazil

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