Summary
Resistant hypertension can be defined in terms of lack of blood pressure response to hypotensive agents, but there may be a big difference between standing and lying blood pressure levels. In general target organ damage and papilloedema improve if the standing blood pressure is controlled; however, progression can occasionally be documented when only the supine blood pressure remains uncontrolled.
Resistant hypertension was a frequent phenomenon when ganglion blocking agents and hydrallazine were the only effective hypotensive agents. With the advent of the thiazides, effective control of the blood pressure became the exception rather than the rule; however, it was not until the advent of adrenergic blocking agents that reduction of supine blood pressures was regularly achieved. The addition of hydrallazine or prazosin to a combination of a thiazide and β-adrenoreceptor blocking agent produces a further significant fall in the blood pressure lying and standing. This combination will control the blood pressure in most patients, but a few remain refractory to maximum doses and will require treatment with oral diazoxide or minoxidil. Both these powerful vasodilators are very effective in resistant hypertension. Oral diazoxide permits excellent control and allows a 10-fold reduction in the doses of other agents. Minoxidil usually needs to be combined with moderate doses of β-blocking agents to reduce the marked reflex tachycardia. Only a 50% reduction in other hypotensive agents was achieved in patients treated with minoxidil and two patients proved resistant to minoxidil, but subsequently responded to oral diazoxide.
Similar content being viewed by others
References
Axford, A.T. and Gilchrist, L.: Propranolol in the treatment of hypertension. British Journal of Clinical Practice 25: 326 (1971).
Fang, P.; Macdonald, I.; Laver, M; Hua, A. and Kincaid-Smith, P.: Oral diazoxide in uncontrolled malignant hypertension. Medical Journal of Australia 1: 621–624 (1974).
Freis, E.D. and Wilson, I.M.: Potentiating effect of chlorothiazide (Diuril) in combination with antihypertensive agents. Medical Annals of the District of Columbia 26: 468–516 (1957).
Harington, M. and Kincaid-Smith, P.: Effect of chlorothiazide on hypotensive action of mecamylamine and on its urinary excretion. Lancet 1: 403–405 (1958).
Harington, M.; Kincaid-Smith, P. and McMichael, J.: Results of treatment in malignant hypertension. A seven year experience in 94 cases. British Medical Journal 2: 969–980 (1959).
Kincaid-Smith, P.; Fang, P. and Laver, M.G: A new look at the treatment of severe hypertension. Clinical Science and Molecular Medicine 45 (Suppl. 1): 75–87s(1973).
Kincaid-Smith, P.; Macdonald, I.M.; Hua, A.; Laver, M.C and Fang, P.: Changing concepts in the management of hypertension. Medical Journal of Australia 1: 327–332 (1975).
Laver, M.G; Fang, P. and Kincaid-Smith, P.: Double-blind comparison of two beta-blocking drugs with previous therapy in the treatment of hypertension. Medical Journal of Australia 1: 174–176 (1974).
Prichard, B.N.G and Gillam, P.M.S.: Treatment of hypertension with propranolol. British Medical Journal 1: 7 (1969).
Zacest, R.; Gilmore, E. and Koch-Weser, J.: Treatment of essential hypertension with combined vasodilation and beta-adrenergic blockade. New England Journal of Medicine 286: 617–622 (1972).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kincaid-Smith, P.S. The Treatment of Resistant Hypertension. Drugs 11 (Suppl 1), 78–86 (1976). https://doi.org/10.2165/00003495-197600111-00020
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-197600111-00020