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Resistant Hypertension: Time to Consider the Best Fifth Anti-Hypertensive Treatment

  • Resistant Hypertension (L Drager, Section Editor)
  • Published:
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Abstract

Purpose of Review

Resistant hypertension (RH) is a growing clinical condition worldwide associated with target-organ damage and poor prognosis compared to non-resistant counterparts. The purpose of this review is to perform a critical evaluation of preferable drug choices for managing RH highlighting the evidence that significant proportion of patients remained uncontrolled despite using four anti-hypertensive drugs.

Recent Findings

Until recently, the fourth drug therapy was main derived from personal opinion or small interventional studies. The recent data derived from two multicentric randomized trials, namely PATHWAY-2 and ReHOT, pointed spironolactone as the preferable fourth drug therapy in patients with confirmed RH as compared to bisoprolol and doxazosin (PATHWAY-2) as well as clonidine (ReHOT). However, significant proportion of patients (especially observed in ReHOT trial that used 24-h ambulatory blood pressure monitoring) did not achieve optimal blood pressure with the fourth drug. This finding underscores the need of new approaches and treatment options in this important research area.

Summary

The current evidence pointed that significant proportion of RH patients are requiring more than four drugs for controlling BP. This statement is particularly true considering the new criteria proposed by the 2017 Guidelines for diagnosing RH (> 130 × 80 mmHg). New combinations, drugs, or treatments should be tested aiming to reduce the RH burden. Based on the aforementioned multicentric trials, we proposed the first five preferable anti-hypertensive classes in the overall context of RH.

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Authors and Affiliations

  1. Hypertension Unit, Renal Division, University of Sao Paulo Medical School, São Paulo, Brazil

    Andrea Pio-Abreu & Luciano F. Drager

  2. Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, São Paulo, Brazil

    Luciano F. Drager

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  1. Andrea Pio-Abreu
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  2. Luciano F. Drager
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Correspondence to Luciano F. Drager.

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

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This article is part of the Topical Collection on Resistant Hypertension

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Pio-Abreu, A., Drager, L.F. Resistant Hypertension: Time to Consider the Best Fifth Anti-Hypertensive Treatment. Curr Hypertens Rep 20, 67 (2018). https://doi.org/10.1007/s11906-018-0866-y

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