Resistant hypertension:
- Resistant hypertension is defined as uncontrolled blood pressure despite the use of three or more antihypertensive drugs, including a diuretic, in optimal doses. These patients may be experiencing of the following factors as the cause of resistant hypertension:
- Inadeguate treatment. Patients may not be on an effective drug, or concomitant volume expansion may occur as a side effect of the drug.
- Extracellular volume expansion. May occur because of renal insufficiency, sodium retention due to treatment with vasodilators ,high-salt diet, or insufficient dosing of diuretic.
- Poor compliance with medical therapy or dietary modifications. This should be addressed with patient education, simplification of the drug regimen, and use of drugs with the fewest adverse effects.
- Secondary hypertension: Whenever confronted with resistant hypertension, Chronic kidney disease ,drug-induced hypertension, obstructive sleep apnea and primary aldosteronism represent the most common secondary causes of resistant hypertension.
- Several drugs can induce or exacerbate pre-existing hypertension, with non-steroidal anti-inflammatory drugs being the most common due to their wide use. secondary causes of hypertension should be excluded.