Involvement of Health Professionals: From the General Practitioner to the Hypertension Specialist and the Hypertension Center

  • Massimo VolpeEmail author
  • Giuliano Tocci


Resistant or refractory hypertension is a very complex disease, being characterized by persistently high blood pressure (BP) levels above the recommended BP goals (i.e., below 140/90 mmHg) in the presence of lifestyle changes and optimal antihypertensive strategy based on at least three antihypertensive agents, including a diuretic at adequate doses. As such, this condition is associated with higher risk of cardiovascular morbidity and mortality than essential hypertension and deserves specific pharmacological and non-pharmacological interventions to reduce this risk. Several reasons can be advocated to explain why BP remains persistently high, although it is often quite difficult to identify a specific pathophysiological aspect that may induce and maintain high BP levels despite optimal pharmacological and non-pharmacological therapies. Whatever the case, it is quite evident that these patients need a multidisciplinary and integrated clinical approach to ensure persistence on favorable lifestyle measures, high adherence and compliance to prescribed antihypertensive therapy, and accurate out-of-office (home and ambulatory) BP measurements. In this chapter, we will discuss the potential impact of a multidisciplinary and multidimensional approach for improving BP control in patients with resistant or refractory hypertension and the role of different professional figures involved in the clinical management of hypertension in this high-risk population. We will also briefly address the importance of counseling from trained nurses and the key role of patients’ relatives among non-pharmacologic interventions, which may help to achieve better BP control and improve adherence to prescribed therapy in patients with resistant forms of hypertension.


Resistant hypertension Hypertension specialist Hypertension center Multidisciplinary approach  Professional figures  Professional skill 


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Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  1. 1.Department of Clinical and Molecular MedicineUniversity of Rome “Sapienza”RomeItaly

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