Resistant Hypertension

• DOI: 10.1161/01.hyp.0000016176.16042.2f
• Publication Date: 2002-07-28T23:16:47Z
• Authors: Sandra J. Taler; Stephen C. Textor; Jo Ellen Augustine
• Keywords: Male; Adrenergic beta-Antagonists; Hemodynamics; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Calcium Channel Blockers; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Heart Rate; Hypertension; Humans; Female; Nursing Care; Vascular Resistance; Antihypertensive Agents; Aged; Follow-Up Studies

Although resistant hypertension affects a minority of all hypertensives, this group continues to experience disproportionately high cardiovascular event rates despite newer antihypertensive agents. Hypertension represents an imbalance hemodynamic forces within the circulation, usually characterized by elevated systemic vascular resistance. We studied utility serial parameters in selection and titration medication hypertensive patients using highly reproducible noninvasive measurements thoracic bioimpedance. Resistant (n=104) were randomized drug based either on (HD) predefined algorithm or directed specialist (SC) 3-month intensive treatment program. Blood pressure was lowered intensified therapy both groups (169±3/87±2 139±2/72±1 mm Hg HD versus 173±3/91±2 147±2/79±1 SC, P <0.01 for systolic diastolic BP), similar numbers intensity medications. pressures reduced further those treated according measurements, resulting improved control (56% 33% SC controlled ≤140/90 Hg, <0.05) incremental reduction resistance measurements. number taking diuretics did not differ between groups, final diuretic dosage higher cohort. Our results demonstrate superior blood compared with clinical judgment alone prospective study. fluid volume support occult expansion as mediator use impedance guide advancing dose adjustment multidrug treatment.