Resistant Hypertension Workup and Approach to Treatment

Table 3

Resistant hypertension workup.

Identify and correct pseudoresistance
(i) Perform proper measurements of blood pressure.; (ii) Evaluate white coat hypertension with reliable home or 24-hour blood pressure measurements.; (iii) Evaluate patient adherence and improve it with education, prescription of the least costly effective drug regimen with the fewest potential adverse effects. Prefer once daily fixed-dose combination products.
Lifestyle modifications
(i) Ask the patient about use of any pharmacological/herbal substances that may increase blood pressure.; (ii) Evaluate of the amount of alcohol intake.; (iii) Evaluate dietary salt intake and recommend sodium restriction to <100 mmol (2.4 g) per day.; (iv) Assess the degree of obesity, abdominal obesity, and physical activity and recommend weight reduction and regular aerobic exercise (at least 30 min/day, most days of the week).
Identify factors contributing to true resistance
(i) Evaluate renal function with estimation of glomerular filtration rate and modify treatment accordingly.; (ii) Search for causes of secondary hypertension

Tailor treatment according to patient characteristics using optimal doses of appropriate medications. If all fails refer to hypertension specialist.