ABSTRACT
Hypertensive patients whose clinical blood pressure (BP) remains persistentlyhigh despite being prescribed appropriate multiple medicationspresent a relatively common clinical problem (1). Despite extensive diagnostic workup, in many cases it is not possible to find a potentially correctablecause of the elevated BP, even though complianceto medication seems to be adequate (2,3). The so-called resistant or resistant hypertension (RH) has been defined as when a therapeutic plan that includes attention to lifestyle measures and the prescription of at least three drugs, one of them a diuretic, in adequate doses has failed to lower systolic and diastolic BP (SBP, DBP) “sufficiently.” The BP values that are considered “sufficient” have changed over time, but currently, the goal of 140/90 mmHg is accepted. In some studies, resistant hypertension included subjects who require four or more drugs to achieve BP control. Interest in resistant hypertension exploded with the recent introduction of new nonpharmacological approaches to BP control, namely, renal denervation and carotid baroreceptor stimulation. In the present chapter, we update the clinical burden, diagnostic evaluation, and pharmacological treatment, as the invasive nonpharmacological approach is included in Chapter 36.
