Causes of refractory hypertension

Hypertension is considered refractory if the blood pressure (BP) cannot be reduced below 140/90 mmHg in patients who are compliant with an appropriate triple-drug regimen that includes a diuretic, with all the component prescribed in near maximal or tolerated doses.

The most common causes are poor compliance, alcohol access and obesity. In addition, blood pressure becomes increasingly difficult to control in the presence of deteriorating renal function.

Additional etiologies include renal artery, stenosis, sleep apnea and the other secondary causes of hypertension. Other causes: nonadherence to therapy, white coat hypertension, pseudo-hypertension, antihypertensive drug dose too low, and sedentary lifestyle.

Approximately 10% of patients with refractory hypertension will have a secondary cause, medication use and compliance, nonpharmacologic management strategies and excessive alcohols use are frequently overlooked causes.
Causes of refractory hypertension

What is refractory hypertension?

Secondary hypertension can be insidious in its presentation and in many cases presents as refractory hypertension.

Refractory hypertension was defined as BP that remained uncontrolled after more or 3 visits to a hypertension clinic within a minimum 6-month follow-up period. Refractory hypertension represents the extreme phenotype of hypertension treatment failure and is also defined as the persistence of blood pressure more than 140/90 mmHg while being treated with a rational triple-drug therapy, optimally including a diuretic.

Refractory hypertension falls into two broad categories:
*Apparent resistance
*True resistance

Refractory hypertension is present in approximately 10% in a primary care setting and in more than 30% of patients seen in subspecialty clinics.

Approximately 10% of patients with refractory hypertension will have a secondary cause. Medication use and compliance, non-pharmacologic management strategies and excessive alcohol issue are frequently overlooked causes.
What is refractory hypertension?