Sydney Renal Services - Resistant Hypertension
Sydney Renal Services - Renal Consulting, Hypertension, Dialysis, Transplantation
Resistant hypertension                                                                                                                BP above goal in spite of  three antihypertensive agents OR
BP that is controlled with four or more medications. (One should be a diuretic)
(All should be prescribed at optimal dosages). 
Refractory hypertension
Resistant hypertension despite maximal medical therapy. (upto 10% patients)
Pseudoresistant hypertension 
1. Inaccurate measurement of blood pressure (eg, use of an inappropriately small blood pressure cuff), 
2. Poor compliance 
3. white coat hypertension.
Exclude 
Suboptimal therapy, 
Lifestyle and dietary issues, 
Medications (NSAIDs, certain anti depressants, OCPs and herbal preparations 
Secondary causes of hypertension such as (see next page), 
    primary aldosteronism, 
    renal artery stenosis
    chronic kidney disease
obstructive sleep apnea 
Less common pheochromocytoma, Cushing's syndrome, and aortic coarctation. 
Investigations EUC, glucose and a urinalysis, plasma aldosterone renin ratio. A 24-hour urine sodium excretion, creatinine clearance, and aldosterone excretion. ambulatory blood pressure monitoring. 

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