[What is resistant hypertension and how to diagnose it?]

WHAT IS RESISTANT HYPERTENSION AND HOW TO DIAGNOSE IT?. High blood pressure is one of the leading factors influencing the cardiovascular risk. Despite current knowledge on the management of hypertension and the numerous antihypertensive drugs available, hypertension remains insufficiently controlled and part of these « uncontrolled » patients meet the definition of resistant hypertension. Resistant hypertension is defined by the failure to achieve blood pressure target (office blood pressure smaller than 140/90 mm Hg) despite appropriate treatment with optimal doses of three antihypertensive drugs, ideally a combination of a renin angiotensin system blocker, a calcium channel blocker and a diuretic. Pseudoresistance should be excluded by using 24 h ambulatory blood pressure or home blood pressure measurements. The management of resistant hypertension includes the identification of lifestyle factors such as obesity, excessive alcohol and dietary sodium intake, volume overload, drug-induced hypertension and the screening of secondary forms of hypertension. The treatment associates lifestyle changes, reinforcement of adherence to treatment, discontinuation of interfering substances, association of antihypertensive drugs on top of the initial triple therapy, especially aldosterone antagonists (spironolactone) as fourth line treatment. Follow-up should be based on home blood pressure.