Clinical Strategies For Managing Resistant Hypertension: Emerging Tools and Therapeutic Insights - Episode 9
Adding a Fourth Agent for RH
Panelists discuss how aggressive blood pressure targets below 130 mm Hg (preferably 120 mm Hg) should be pursued in most resistant hypertension patients using combination therapies, while individualizing goals based on patient age, tolerability, and comorbidities.
Video content above is prompted by the following:
Current evidence supports intensive blood pressure control below 130 mm Hg, with many experts advocating for targets below 120 mm Hg when tolerated. The SPRINT trial and recent diabetes studies demonstrate improved cardiovascular outcomes with lower blood pressure targets, including potential cognitive benefits. Clinicians should not hesitate to add fifth or sixth antihypertensive agents when patients remain above target despite optimal therapy with 4 medications.
Treatment intensification must balance aggressive targets with individual patient factors, including age, comorbidities, and functional status. Younger patients with end-organ damage warrant more aggressive approaches, while older patients require careful assessment for orthostatic hypotension and fall risk. The key principle involves achieving the lowest tolerable blood pressure while monitoring for symptoms and maintaining quality of life.
Successful resistant hypertension management requires combining multiple therapeutic modalities rather than relying on single interventions. Renal denervation, various medication classes, and lifestyle interventions can be used synergistically. With over 10 million Americans having resistant hypertension, clinicians need diverse treatment options including peripheral alpha blockers, combination pills, and newer agents like endothelin receptor antagonists to achieve optimal outcomes across different patient populations.
