A REVIEW ON COMMON SECONDARY ANTECEDENTS OF RESISTANT HYPERTENSION AND ITS MANAGEMENT

*Haritha Peruvankuzhiyil, Nasiya N., Jerrin Jose K., Dr. Shijikumar P. S. and Dr. Sirajudheen M. K.

ABSTRACT

Hypertension is a state in which the force of the blood against the artery walls is too high usually 140/90, and is considered severe if the pressure is above 180/120. Hypertension becomes resistant due to uncontrolled blood pressure despite the use of three antihypertensive drugs, including a diuretic, in optimal doses. The most common antecedents or causes of resistant hypertensions are poor patient adherence, physician inertia, inadequate doses, excess alcohol intake, and incorrect combination of antihypertensive drugs. Patient whose blood pressure is controlled but require 4 or more medication to do so should also be considered resistant to the treatment. The secondary forms of resistant are endocrine disorders, renal disease, neurological disorders, chronic kidney disease, acute stress, drug induced hypertension, obstructive sleep apnea and primary aldosteronism. Most commonly it is found in the patients having chronic kidney disease and cardiovascular disease. The management of resistant hypertension includes the evaluation for secondary causes of hypertension, pharmacological management of resistant hypertension, newer drugs for the management of resistant hypertension, interventional management of resistant hypertension, reduction of dietary sodium intake, exclusion of drugs induced hypertension and verification of true resistant hypertension. This review mainly aimed at the common secondary antecedents of resistant hypertension and its management.

Keywords: Resistant hypertension, obstructive sleep apnea, aldosteronism, secondary causes.