What's on this Page
How is Resistant hypertension treated
What are the treatment options for RH—a philosophical approach?
Rational management of RH requires a systematic approach based on the direct causes of the RH. It should be re-emphasized that because uncontrolled hypertension can cause significant morbidity and mortality, aggressive therapeutic management should be implemented. An overall management approach should be based on careful evaluation and rational medical therapy, which may be complex.
Doctors should try to reduce the pill burden with combination medications where possible.
Correction of volume overload is one of the key strategies in managing RH. Excessive salt intake must be curtailed. Adequate diuretic therapy should be implemented. The doses of antihypertensive drugs should be titrated systematically to determine whether the patient is responding to the treatment. Drug interactions should be considered and eliminated in the treatment of hypertension. Patients should be supplied with a complete list of drugs that can increase BP: steroids, oral contraceptives, sympathomimetics, nasal decongestants, cocaine, appetite suppressants, and so on. Patients should be counseled about alcohol consumption, weight control, salt intake, and regular physical activity. Conditions such as obstructive sleep apnea or chronic pain should be vigorously addressed.
Secondary causes of hypertension, such as those listed in Box 67.2 , should be considered in the overall evaluation of patients with RH. Any underlying cause should be corrected, if possible, to permit better BP control. Patients with RH experience and suffer from a high degree of target organ damage.
