{"title":"[RESISTANT ARTERIAL HYPERTENSION – APPROACH TO PATIENT IN FAMILY\nMEDICINE].","authors":"I Diminić-Lisica, L Bukmir, I Lisica","doi":"","DOIUrl":null,"url":null,"abstract":"<p><p>Increasing the proportion of patients with controlled hypertension implies understanding and systematic approach to\npatients with resistant hypertension. In the past decades, an increase in the prevalence of resistant arterial hypertension\n(RAH) has been observed and the incidence of this problem is becoming greater in the practice of family physicians.\nPatients with RAH have a higher prevalence of target organ damage as compared with patients having achieved target\nblood pressure values, and their risk of an adverse cardiovascular event is tripled. RAH is defined as hypertension in which\nthere is no satisfactory control of blood pressure despite compliance to lifestyle changes and taking at least three drugs\nin full doses, one of which has to be a diuretic. The most important risk factors for resistance to treatment are older age,\nobesity, smoking, excessive intake of salt and alcohol, the presence of left ventricular hypertrophy, chronic renal failure,\ndiabetes, inadequate baroreflex pathway, chronic stress and associated mental states, use of some drugs, and all forms of\nsecondary hypertension. One-fifth of patients with RAH have primary aldosteronism. Obstructive sleep apnea is a common\ncause of RAH, and literature reports point to its increasing frequency. Optimal treatment involves a combination of three\ndrugs, one of which is a diuretic. Use of mineralocorticoid antagonist as the fourth drug has shown significant efficacy even\nin patients who do not have elevated levels of aldosterone. New invasive methods of treatment include renal denervation\nand permanent electrical stimulation of the carotid sinus. The aim of this paper is to emphasize the importance of RAH\nas a cardiovascular risk factor, along with early detection and treatment at the family medicine level and timely referral to\nadditional procedures to treat the specific forms of RAH.</p>","PeriodicalId":35756,"journal":{"name":"Acta Medica Croatica","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2016-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta Medica Croatica","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Increasing the proportion of patients with controlled hypertension implies understanding and systematic approach to
patients with resistant hypertension. In the past decades, an increase in the prevalence of resistant arterial hypertension
(RAH) has been observed and the incidence of this problem is becoming greater in the practice of family physicians.
Patients with RAH have a higher prevalence of target organ damage as compared with patients having achieved target
blood pressure values, and their risk of an adverse cardiovascular event is tripled. RAH is defined as hypertension in which
there is no satisfactory control of blood pressure despite compliance to lifestyle changes and taking at least three drugs
in full doses, one of which has to be a diuretic. The most important risk factors for resistance to treatment are older age,
obesity, smoking, excessive intake of salt and alcohol, the presence of left ventricular hypertrophy, chronic renal failure,
diabetes, inadequate baroreflex pathway, chronic stress and associated mental states, use of some drugs, and all forms of
secondary hypertension. One-fifth of patients with RAH have primary aldosteronism. Obstructive sleep apnea is a common
cause of RAH, and literature reports point to its increasing frequency. Optimal treatment involves a combination of three
drugs, one of which is a diuretic. Use of mineralocorticoid antagonist as the fourth drug has shown significant efficacy even
in patients who do not have elevated levels of aldosterone. New invasive methods of treatment include renal denervation
and permanent electrical stimulation of the carotid sinus. The aim of this paper is to emphasize the importance of RAH
as a cardiovascular risk factor, along with early detection and treatment at the family medicine level and timely referral to
additional procedures to treat the specific forms of RAH.
期刊介绍:
ACTA MEDICA CROATICA publishes original contributions to medical sciences, that have not been previously published. All manuscripts should be written in English.