What causes refractory hypertension?
Most common secondary causes of resistant hypertension are obstructive sleep apnea, renal artery stenosis, renal parenchymal disease, and primary aldosteronism while some uncommon causes such as pheochromocytoma, Cushing’s disease, thyroid and parathyroid dysfunction; and aortic coarctation also contribute to resistant …
What is refractory hypertension?
Refractory hypertension is defined as uncontrolled blood pressure despite use of ≥5 antihypertensive agents of different classes, including a long-acting thiazide-like diuretic and an MR (mineralocorticoid receptor) antagonist, at maximal or maximally tolerated doses.
What is the difference between refractory and resistant hypertension?
Refractory hypertension is a recently proposed phenotype of antihypertensive treatment failure. As such it represents an extreme subtype of resistant or difficult-to-treat hypertension. Resistant hypertension is relatively common with an estimated prevalence of 10–20% of treated hypertensive patients.
How is refractory hypertension treated?
Treatment of resistant hypertension is focused on the addition of fourth-line therapy where blood pressure is not controlled by treatment with three drugs, described by NICE as A+C+D: that is, an ACE inhibitor or an angiotensin II receptor blocker (A), a calcium channel antagonist (C), and a thiazide or thiazide-like …
Can resistant hypertension be treated?
If you have been taking your medication correctly and still have resistant hypertension, your doctor may choose to add another medication. The most common classes of blood pressure medicines are diuretics, calcium channel blockers, and ACE inhibitors/angiotensin receptor blockers (ARBs).
How is refractory hypotension treated?
Higher doses of catecholamines and/or vasopressin are usually required in refractory hypotension from a decreased response to endogenous or exogenous vasoactive substances such as angiotensin II and vasopressors (83).
How do you know if you have resistant hypertension?
If you have resistant hypertension: Your blood pressure stays high (reading of 130/80 mmHg and above) — even if you take three blood pressure-lowering medications including one diuretic (water pill). You are taking four or more medications to control your high blood pressure.
How does resistant hypertension happen?
Hypertension is considered resistant when all of the following are true: Someone is taking three* different blood pressure medications at their maximally tolerated doses. One of the blood pressure medications is a diuretic (removes fluid and salt from the body).
Can resistant hypertension reversed?
Resistant hypertension has several possible causes, including another underlying medical condition, but many of those causes are reversible.
What causes refractory hypotension?
The most important step to treat refractory hypotension is to determine the primary cause(s). These include two main reasons, hypovolemia and/or sepsis, and within them the whole spectrum of possibilities, from blood loss, dehydration, sympathetic inactivity or inability to respond, metabolic acidosis, and endotoxemia.