Emerging Treatment Options in Patients With Difficult-to-Treat Hypertension - Episode 8
Managing Resistant Hypertension
A panelist discusses how comorbidities like chronic kidney disease, obesity, and diabetes complicate resistant hypertension treatment by limiting therapeutic options and affecting medication adherence, while emphasizing that treatment should begin with lifestyle modifications and rationalizing the foundational three-drug regimen before intensifying therapy.
Comorbidities and Initial Treatment Strategy
Chronic kidney disease is one of the most common comorbidities in resistant hypertension patients and unfortunately limits treatment options. Obesity significantly contributes to resistant hypertension, while diabetes and other comorbidities often require multiple medications that can impact adherence and resistance to therapy. The foundation of treatment always begins with lifestyle modifications including dietary changes, weight loss, increased exercise, elimination of interfering substances, and sodium reduction - with sodium restriction being particularly important for chronic kidney disease patients despite being difficult to achieve.
Before intensifying pharmacologic therapy, clinicians should rationalize the medication regimen. Many resistant hypertension patients have complex medication histories from multiple providers that may not make pharmacological sense. Guidelines recommend establishing a foundational three-drug regimen including a renin-angiotensin system blocker (ACE inhibitor or ARB), a calcium channel blocker, and a thiazide-type diuretic (for patients with normal renal function). This rationalized approach creates a solid baseline before considering fourth or fifth medications or interventional treatments for resistant hypertension.
