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Refractory hypertension: what do we know so far?

Journal of Human Hypertension volume 35, pages 181–183 (2021)Cite this article

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Refractory hypertension is currently defined as the failure of office blood pressure (BP) control despite the use of five or more antihypertensive drugs including a long-acting thiazide-like diuretic (ideally chlorthalidone) and a mineralocorticoid receptor antagonist (MRA) [1]. Initially considered as an extreme phenotype of resistant hypertension, recent studies have suggested that they present different pathophysiological mechanisms and refractory hypertension may be a new clinical condition [2, 3].

The first point of discussion is the definition of refractory hypertension. Considering that after the diagnosis of resistant hypertension (use of three or more drugs without control of office BP) [4], the use of Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM) becomes mandatory in the diagnostic and therapeutic approach of these patients, in whom the office BP has low value [4,5,6], ideally refractory hypertensive patients should also be followed-up with ABPM or HBPM [3]. Thus, the definition of refractory hypertension might be more reliable and compatible with the clinical practice if it would not be based on office BP but on noncontrolled ABPM or HBPM, which has been called true refractory hypertension [7]. Furthermore, it is crucial to assess non-pharmacological and pharmacological adherence, besides clinical characteristics of these patients to exclude false positive diagnosis [7, 8].

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Fig. 1: Clinical approach of refractory hypertension.

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Funding

This study was supported by research grants from the Conselho Brasileiro de Desenvolvimento Científico e Tecnológico (CNPq, Distrito Federal, Brazil). The sponsors have no role in in preparation, review and approval of the paper.

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Authors and Affiliations

  1. Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Elizabeth Silaid Muxfeldt

  2. Department of Internal Medicine, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Bernardo Chedier

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  1. Elizabeth Silaid Muxfeldt
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Correspondence to Elizabeth Silaid Muxfeldt.

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Muxfeldt, E.S., Chedier, B. Refractory hypertension: what do we know so far?. J Hum Hypertens 35, 181–183 (2021). https://doi.org/10.1038/s41371-020-00409-z

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