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:
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:
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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