Resistant Hypertension: An Update

With the recent publication of the revised American Heart Association (AHA) Scientific Statement on Resistant Hypertension: Detection, Evaluation, and Management as well as other critical documents, major advances have been in our in how resistant hypertension (RHTN) and is defined, diagnosed, and best treated as well as our understanding of the pathophysiology of RHTN.¹ The new Scientific Statement is important in defining RHTN much more comprehensively than simply based on the blood pressure (BP) level and number of prescribed medications as it has been expanded to incorporate exclusion of common pseudocauses of treatment resistance, specifically inaccurate BP measurement, a prominent white-coat effect, undertreatment, and poor medication adherence. The new American College of Cardiology (ACC)/AHA hypertension guidelines are important in providing a preliminary estimate of the prevalence of RHTN based on the now lower recommended BP goal of 130/80 mm Hg.² The landmark PATHWAY-2 study adds importantly to our understanding of the pathophysiology of RHTN and provides compelling evidence for the most effective multiple-drug combination for treating RHTN, including especially, preferential use of spironolactone.³ This editorial serves to highlight these recent advances.

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