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.