12 1 2 What Is Resistant Hypertension (RH)? Resistant hypertension (RH) is defined as: • Above-goal BP despite the concurrent use of three antihypertensive drug classes at maximally tolerated doses, including a diuretic. or • Hypertension with four or more concurrent medications to achieve target BP. People with resistant hypertension remain at increased risk for target organ damage, morbidity and mortality despite ongoing antihypertensive drug therapy. 5-Introduction Most patients with hypertension respond to pharmacotherapy, but not all. Some people have treatment-resistant hypertension despite conscientious clinical management. The most common classes of antihypertensive agents used for individuals with difficult-totreat hypertension include: • A long-acting CCB • An RAS blocker (either an ACE inhibitor or an ARB) • A diuretic Apparent RH or True RH? True treatment-resistant hypertension requires three elements: 1. Appropriate antihypertensive drug regimen 2. Medication adherence 3. Elevated BP both in and out of office There are two types of aTRH: Uncontrolled aTRH BP ≥130/80 mm Hg on ≥3 BP medications Controlled aTRH BP ≤130/80 mmHg on ≥4 medications, unless otherwise specified5-Prevalence of RH If one or more elements is missing, then the patient has apparent treatmentresistant hypertension (aTRH). The conditions on the next page must be excluded before diagnosing true resistant hypertension.
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