The American Heart Association (AHA) has issued an updated scientific statement on the detection, evaluation, and management of resistant hypertension (RH). Areas covered in the updated statement for diagnosing RH include identifying and correcting medication non-adherence, analyzing whether blood pressures (BPs) have been taken correctly, understanding the white coat effect, and if there is suboptimal antihypertensive therapy being recommended. Among the highlights:
- Lifestyle factors such as obesity, dietary sodium, alcohol consumption, physical inactivity, and dietary pattern are all linked to RH.
- Several classes of pharmacologic agents can increase BP and contribute to drug-induced RH, including NSAIDs, oral contraceptives and hormone replacement therapy, and immunosuppressive agents.
- Evaluation of RH should start with a thorough medical history, physical examination, collection in out-of-office BP monitoring, laboratory evaluation, and non-invasive imaging if warranted.
- Management of RH incorporates lifestyle interventions and adding exercise to the management regimen. It also includes pharmacological treatment and referral to a hypertension specialist if warranted.
Carey RM, Calhoun DA, Bakris GL, et al. Resistant hypertension: Detection, evaluation, and management. A scientific statement from the American Heart Association. [Published online ahead of print September 13, 2018]. Hypertension. doi:10.1161/HYP.0000000000000084.
This Week's Must Reads
Trends in LDL-C and 2013 Treatment Guidelines, Clin Cardiol; ePub 2018 Nov 15; Superko, et al
PCSK9 Inhibitors Reduce Risk of CV Events, Nat Rev Cardiol; ePub 2018 Nov 12; Sabatine, et al
Risk Factors for CVD in Heterozygous FH, J Clin Lipidol; ePub 2018 Nov 7; Akioyamen, et al
Hypercholesterolemia Patients on Suboptimal Statins, J Atheroscler Thromb; ePub 2018 Oct 26; Kajinami, et al
Cholesterol Guidelines Stress Lifetime Approach, Circulation; ePub 2018 Nov 10; Grundy, et al
Must Reads in Hypertension
Hypertension and ECG-LVH and CV Mortality, Am J Cardiol; ePub 2018 Oct 18; Cao, et al
Obtaining a Reliable Estimate of Home Blood Pressure, J Am Heart Assoc; ePub 2018 Oct 5; Bello, et al
Detection & Management of Resistant Hypertension, Hypertension; ePub 2018 Sep 13; Carey, et al
Lead Exposure & BP Trends in Children, Am J Cardiol; ePub 2018 Sep 7; Zachariah, et al
Clinic, Home, and Ambulatory BP & WMH Burden, Am Heart J; ePub 2018 Aug 11; White, et al