Resistant hypertension is defined as high blood pressure. It remains above goal in spite of the concurrent use of three anti hypertensive agents of different classes. These anti hypertensive agents are angiotensin-converting enzyme inhibitor, a calcium channel blocker and a diuretic. All these agents are prescribed at optimal dose amounts. It is a significant cause of morbidity and mortality worldwide. Some symptoms of resistant hypertension are severe headaches, anxiety, shortness of breath and nosebleeds.
There are some causes of resistant hypertension such as primary causes and secondary causes. Primary causes are related with both patient and physician. High sodium intake, lack of life style adherence and poor adherence are some causes of patient related whereas progressive renal insufficiency, sub clinical volume over load and inadequate use of diuretics are causes of physician related. Renal artery stenosis, thyroid diseases, intracranial tumours and Cushing’s syndrome are some secondary causes of resistant hypertension.
According to study, “Resistant Hypertension Global Clinical Trials Review, H1, 2018” some of the major companies that are working in the resistant hypertension are ViforPharma AG, Novartis AG, Johnson & Johnson, IMMD Inc, Gilead Sciences Inc, Pfizer Inc, Metabolic Research Institute Inc, Idorsia Pharmaceutical Ltd, C. H. BoehringerSohn AG & Co KG, Accelovance Inc.
The major factors contributing to hypertension are lifestyle factors, drug related causes and volume overload. Some lifestyle factors are obesity, excess alcohol intake, excess dietary sodium and cocaine & amphetamines misuse. Drug related factors are herbal supplements, liquorice, sympathomimetic agents and contraceptive harmones. Additionally, volume overload factors are high salt intake, inadequate diuretic therapy and progressive renal insufficiency. There are some risk factors are included in resistant hypertension such as diabetes, older age, high baseline blood pressure, black race, chronic kidney disease and obesity etc.
The evolution of resistant hypertension is directed toward many terms, which are confirming true treatment resistance, identification of causes contributing to treatment resistance or including secondary causes of hypertension and documentation of target-organ damage etc.
Some treatments available for resistant hypertension are non-pharmacologic intervention, drug intervention and device therapy. Non-pharmacologic intervention do not involve medications: it included weight loss, regular exercise, moderation of alcohol & caffeine and a high fiber or low fat or low salt diet. A drug intervention is a process that helps a drug addict recognize the extent of their problem. Some drugs spironolactone, clonidine, nebivolol, labetalol, carvedilol CR, eplerenone, guanfacine, reserpine, methyldopa, doxazosin, terazosin, hydralazine, minoxidil and ISMN. Device therapy is defined by two techniques, which are renal sympathetic denervation and carotid baroreflex activation. Renal sympathetic denervation significantly reduces blood pressure in patients with resistant hypertension: it is characterized by increased sympathetic activity such as left ventricular hypertrophy, heart failure, metabolic syndrome, obstructive sleep apnea and atrial fibrillation.
There are many tests are used in investigation of resistant hypertension such as renal echocardiogram, thyroid stimulating hormone, urine analysis (protein, erythrocytes, leukocytes), transthoracic echocardiogram, 12-lead electrocardiogram, complete blood count, ambulatory blood pressure monitoring, renal artery duplex, plasma rennin or aldosterone levels, plasma glucose and 24-hour urine assessment (aldosterone, sodium and albumin).
It is estimated that patients with resistant hypertension are almost 50% more likely to experience an adverse cardiovascular event compare with three or fewer antipertensive agents. Resistant hypertension in adolescents is increasing in frequency. Clinical trial data from Simplicity radio frequency catheter systems have created much interest in the role of the renal nerves in hypertension and other cardiovascular conditions.
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