How do we manage resistant hypertension: recommendations from the American Heart Association (AHA)?

This study reviewed the diagnosis and treatment of resistant hypertension.

Hypertension or high blood pressure (BP) is a common condition. Patients with hypertension have a higher risk of cardiovascular (heart and circulatory system) disease. There is also an increased risk of stroke, disability and death. Hypertension can be managed using medication and lifestyle changes. Some patients do not respond well to BP lowering medication (antihypertensives, AHs). This is called treatment-resistant hypertension (RH). Patients have RH if they do not respond to 3 different types of AH drugs.

Patients with RH have a higher risk of organ damage. Monitoring BP is very important in patients with RH. In 2008, the American Heart Association (AHA) issued recommendations for RH management. Since 2008, a number of studies on RH have been published. This report is an update on RH management.

RH is diagnosed if patients have a BP of 140/90 mmHg or higher and taking 3 or more AHs. AH medication should include a calcium-channel blocker (CCB), a diuretic and an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). Patients that are overweight or obese should aim to reduce body weight by 5-10%. A salt intake of fewer than 2.3 grams per day is recommended for most patients with RH. In terms of overall diet, there are no specific recommendations for RH patients. Patients should continue to follow AHA diet guidelines.

RH patients should participate in regular exercise to control BP. Aerobic exercise should be done 3-5 times per week, in 30-40 minute sessions. Light resistance training (2-3 times per week) is also recommended. Low-intensity exercise may also be beneficial for patients that cannot achieve this. The cause of RH is usually due to high blood volume. Choosing medications that reduce blood volume (diuretics) is important. Adhering to medication is very important for patients with RH. Some medical devices such as renal nerve ablation therapy and baroreceptor activation therapy may be used to improve BP control. These devices help regulate BP by blocking the sympathetic nervous system or increasing the sensitivity of pressure receptors (baroreceptors). These are under ongoing investigation.

This study offered updated expert recommendations on the diagnosis and treatment of resistant hypertension.