Emerging Treatment Options in Patients With Difficult-to-Treat Hypertension - Episode 18
The Future of Resistant Hypertension
A panelist discusses how the epidemic of uncontrolled hypertension affects over 50% of patients and emphasizes that with emerging new drugs, devices, and technologies, healthcare providers will soon need to move beyond simply prescribing three medications and instead systematically utilize all available treatment options to achieve blood pressure control.
Future Directions and Comprehensive Management
The United States faces an epidemic of uncontrolled hypertension, with less than 50% of hypertensive patients achieving adequate control. Despite available information technologies and home blood pressure monitoring devices, healthcare systems struggle to identify uncontrolled patients and prioritize their treatment. The key challenges include identifying these patients, connecting them with appropriate long-term care systems, and prioritizing blood pressure control to reduce cardiovascular event risk by achieving targets below 130/80 as recommended by guidelines.
While numerous treatment modalities exist, including effective medications and devices, the primary challenge lies in implementation - getting these treatments to patients in their homes and ensuring proper adherence and follow-through. With the development of new drugs beyond endothelin antagonists and procedures beyond renal denervation, the standard of care is evolving rapidly. Soon it will be insufficient to simply prescribe three different medications before declaring a patient resistant to therapy; providers, health systems, and payers will need to intensify therapeutic approaches and ensure new technologies and treatments are accessible.
The most important principle in treating resistant hypertension is recognizing that options exist. A systematic approach includes excluding pseudo-resistance and secondary causes, eliminating interfering substances, implementing lifestyle changes, and rationalizing therapy with appropriate medications. Beyond mineralocorticoid receptor antagonists like spironolactone, clinicians now have multiple options including dual endothelin antagonists and interventional procedures like renal denervation. Patients should understand that uncontrolled hypertension is unacceptable and that various treatment pathways are available. The key is identifying these patients, taking a systematic approach, explaining their options, and following through with appropriate treatments.
