AHA updated recommendations for the treatment of resistant hypertension

American Association (AHA) have updated 2008 recommendations for the diagnosis and treatment of resistant hypertension. The provisions of the document published in the journal Hypertension.

Resistant hypertension (RAG) in the current document is defined as:

  • increase in blood pressure (BP) above target value (130 mm Hg. calendar) in patients simultaneously receiving three drugs, including CCB long-acting blocker of the renin-angiotensin (aceis or ARBS) and diuretics at maximum or maximum tolerated doses;
  • target blood pressure values are achieved only when receiving 4 or more antihypertensive drugs.
  • Diagnosis RAG requires a new commitment to the patient’s treatment and exclusion of “white coat effect”. The assessment should include identification of medication influencing the effectiveness of therapy: NSAIDs, oral contraceptives, sympathomimetics, cyclosporine, tacrolimus, erythropoietin, VEGF inhibitors, antidepressants, glucocorticoids, mineralocorticoids, amphetamines.

    When the diagnosis is necessary to exclude secondary hypertension caused by primary aldosteronism, parenchymal renal diseases, renal artery stenosis, pheochromocytoma, Cushing’s syndrome, obstructive sleep apnea, coarctation of the aorta etc.

    In addition to lifestyle changes, treatment of RAG include:

  • use tiazidopodobnye diuretics long-acting (chlortalidone or indapamide);
  • adding antagonists of mineralocorticoid receptors (spironolactone or eplerenone);
  • if the blood pressure remains elevated in a step – wise addition of antihypertensive drugs with complementary mechanism of action.
  • A lifestyle change must be part of a therapy rug. The patient should be recommended a diet low in sodium (less than 2400 mg/day), weight loss, exercise and at least 6 hours of uninterrupted sleep a night.

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