Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Detection & Management of Resistant Hypertension

Hypertension; ePub 2018 Sep 13; Carey, et al

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.