Ruling out Rx non-compliance, white coat syndrome, and interfering medications necessary
THURSDAY, Sept. 13, 2018 (HealthDay News) — A correct diagnosis of resistant hypertension is necessary to avoid overmedicating, according to a scientific statement from the American Heart Association published online Sept. 13 in Hypertension.
Robert M. Carey, M.D., from University of Virginia Health System in Charlottesville, and colleagues from the Professional/Public Education and Publications Committee of the Council on Hypertension reviewed more than 400 studies to update a previous scientific statement on the detection, evaluation, and management of resistant hypertension.
The council recommends that first, antihypertensive medication adherence is confirmed and out-of-office blood pressure (BP) recordings exclude a white-coat effect. Evaluation should then include identification of contributing lifestyle issues, detection of drugs interfering with antihypertensive medication effectiveness, screening for secondary hypertension, and assessment of target organ damage. The council advises that management of resistant hypertension includes maximization of lifestyle interventions, use of long-acting thiazide-like diuretics (chlorthalidone or indapamide), and addition of a mineralocorticoid receptor antagonist (spironolactone or eplerenone). If BP remains elevated, the stepwise addition of antihypertensive drugs with complementary mechanisms of action to lower BP is recommended. If BP still remains uncontrolled, referral to a hypertension specialist should occur.
“Patients with high blood pressure are more likely to develop cardiovascular diseases such as heart attacks, heart failure, and stroke, and their prognosis deteriorates further if they have resistant hypertension,” Carey said in a statement. “It is extremely important to get blood pressure down by whatever means one can, because study after study has shown the negative outcomes from pressures that remain elevated above the target level.”
Several authors disclosed financial ties to the pharmaceutical industry.
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