Jai Radhakrishnan, MD, MS

Current Gaps and How to Cross Them: Looking Ahead in the Management of Resistant Hypertension

Shortcomings in Managing Difficult-to-Treat Hypertension

Despite advances, there are still gaps in the approach to managing difficult-to-treat hypertension. Challenges include limited access to effective medications, difficulty in achieving optimal blood pressure control, and patient adherence issues.

Moving forward, improvements in personalized treatment plans, better access to advanced therapies, and innovations in drug development would greatly enhance the management of resistant hypertension.

Advice for Nephrologists and General Physicians

For nephrologists and general physicians, it is crucial to focus on thorough diagnostic workups, considering factors like lifestyle, comorbidities, and medication adherence. Collaboration and timely referral to specialists can significantly improve patient outcomes

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Discover innovative strategies and tools for effective hypertension management, enhancing patient care and treatment outcomes in today's healthcare landscape.

Clinical Perspectives on Aprocitentan for Hypertension

Experience With Aprocitentan in Clinical Practice

Aprocitentan is increasingly used in clinical practice for managing resistant hypertension. Its effectiveness in lowering blood pressure, especially in patients who have not responded well to other treatments, makes it a valuable option.

Patient Selection Criteria for Aprocitentan

: Aprocitentan is often considered for patients with uncontrolled hypertension despite using a 3-drug regimen, especially in those with additional comorbidities like diabetes or chronic kidney disease.

: Patients who are more likely to respond well to aprocitentan include those with high baseline blood pressure levels and a history of resistant hypertension.

Discover how Aroittenan effectively manages hypertension in patients with chronic kidney disease, offering a reliable alternative for those intolerant to standard treatments.

Overcoming Barriers in Advanced Hypertension Therapy

Challenges in Treating Resistant Hypertension With Third- and Fourth-Line Therapies

The main challenges in using third- and fourth-line therapies for resistant hypertension include:

: These medications can be expensive, and some patients may have limited access due to insurance coverage or financial constraints.

: Adherence to these therapies may be lower due to complex regimens, adverse effects, or the need for multiple medications.

Addressing these issues requires careful patient education, considering generic options where possible, and ensuring that treatment is both effective and manageable for the patient.

Managing hypertension in complex patients involves navigating comorbidities, treatment inertia, and care fragmentation for optimal outcomes.

Expert Perspectives on Treatment Strategies for Resistant Hypertension

Treatment Strategies for Resistant Hypertension


Lifestyle changes such as weight loss, increased physical activity, sodium reduction, and alcohol moderation are key components in managing resistant hypertension.


Maximizing the doses and combinations of a 3-drug regimen—typically a calcium channel blocker, ACE inhibitor or ARB, and a diuretic—can improve control before considering additional therapies.


If blood pressure remains elevated, adding medications like aldosterone antagonists (eg, spironolactone), beta-blockers, or centrally acting agents (eg, clonidine) may be necessary.


In severe cases, devices such as renal denervation or the use of medications like hydralazine or minoxidil may be considered for treatment-resistant hypertension.


Focus should begin with confirming adherence and addressing lifestyle factors. If blood pressure remains high, optimize the current regimen and consider adding fourth- or fifth-line medications, always tailoring treatment to individual patient needs and comorbid conditions.

Explore effective strategies for managing resistant hypertension, including lifestyle changes, medication adjustments, and advanced treatment options.

Jai Radhakrishnan, MD, MS

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