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Resistant hypertension is defined as when the blood pressure cannot be reduced to below 140/90 mmHg in patients who are adhering
to an adequate and appropriate triple drug regimen that includes a diuretic, in near full doses. Before changing or increasing
the antihypertensive medication, several factors should be checked. A careful evaluation of the patient’s adherence to therapy and
adequate measurement of blood pressure are needed to exclude pseudoresistance secondary to poor medical adherence or white coat
hypertension. Patients should be asked regularly about medications or substances that could interfere with blood pressure control.
Successful treatment requires the identification of causes and a reversal of life style factors contributing to treatment resistance.
Diabetes, chronic kidney disease, nonsteroidal anti-inflammatory drugs, high salt intake, obesity, and alcohol abuse are frequent
causes of uncontrolled hypertension in Korea. The diagnosis and appropriate treatment of secondary hypertension is also needed.
When multiple medications are used, vasodilators are the most commonly used antihypertensive drugs that cause subsequent fluid
retention or sympathetic tone elevation. Adequate, effective, and sufficient diuresis and catecholamine suppression are needed for
patients who do not respond to several vasodilators. (Korean J Med 76:398-401, 2009) |
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