Resistant hypertension and hyperaldosteronis

Abstract

ABSTRACT Resistant hypertension is defined as blood pressure that remains uncontrolled in spite of use of at least three antihypertensive medications in effective doses, ideally including a diuretic. Higher obesity rates, older age, and increased use of certain exogenous substances are related to an increasing prevalence of resistant hypertension. The evaluation of patients with resistant hypertension is focused on identifying contributing factors and secondary causes of hypertension. Hyperaldosteronism is now recognized as the most common secondary cause and all patients with resistant hypertension should be screened with a plasma aldosterone/renin ratio even if the serum potassium level is normal. Treatment includes reversal of contributing factors, appropriate treatment of secondary causes, and use of effective multi-drug regimens. Recent studies indicate that the addition of spironolactone to standard treatment regimens induces significant blood pressure reduction in patients with resistant hypertension