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№2' 2015
CARDIOLOGYInternational Medical Journal, Vol. 21., Iss. 2, 2015, P. 15−23.
RESISTANT ARTERIAL HYPERTENSION: DIAGNOSIS AND TREATMENT
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Resistant arterial hypertension is diagnosed when three antihypertensives administration does not result in achieving target blood pressure, which for most patients is the level below 140/90 mm Hg, wherein one of the drugs must be diuretic and all drugs must be administered to optimal or maximum tolerated doses. Although arbitrary number required to control blood pressure drugs, determination is very useful from the point of view of both the clinician and researcher, since it helps to identify the phenotype of resistance to a wide antihypertensive treatment and diagnostic determining tactics, such as testing or causes of secondary hypertension selection treatment. Thus the patients with resistant arterial hypertension have a higher probability of detection of diseases, leading to the development of secondary hypertension. These include sleep apnea, kidney disease, renal artery stenosis, primary aldosteronism. Much more rare causes include Cushing's syndrome, pheochromocytoma, hyperparathyroidism, coarctation of the aorta, intracranial tumors. Referral and specific treatment of these diseases can improve blood pressure control and long−term prognosis. Despite the high prevalence of resistant arterial hypertension, the lack of blood pressure control is often associated with an inadequate selection of antihypertensive therapy, blood pressure misjudgment or failure of patients to medical recommendations. Therefore, before carrying out diagnostic measures it is necessary to assess consistently adequacy of patients receiving therapy that inherent in the definition of resistant arterial hypertension and exclude pseudoresistance.
Key words: resistant arterial hypertension, diagnosis, treatment.