Resistant Hypertension Workup and Approach to Treatment
Table 1
Causes of resistant hypertension.
Exogenous substances
Drug related (see Table 2) Herbal preparations (licorice, ephedra, ginseng, yohimbine, ma huang, and bitter orange) Alcohol consumption Excess sodium intake
Concomitant conditions
Obesity Insulin resistance Smoking
Pseudoresistance
White-coat hypertension Pseudohypertension in the elderly Measurement artifact Physician inertia
Secondary causes of hypertension
(i) Common causes
Renovascular disease Renal parenchymal disease Primary aldosteronism Pheochromocytoma Cushing syndrome Thyroid and parathyroid disease Coarctation of the aorta
(ii) Rare causes
Aneurysm located at the bifurcation of the right renal artery Arterial thrombosis from abdominal aorta to both common iliac arteries Occlusion of the left renal artery Hypercalcemia Carcinoid syndrome Central nervous system tumors Premenstrual syndrome