Short communication, Note

RESISTANT ARTERIAL HYPERTENSION – APPROACH TO PATIENT IN FAMILY MEDICINE

INES DIMINIĆ-LISICA ; University of Rijeka, School of Medicine, Department of Family Medicine, Rijeka, Croatia
LEONARDO BUKMIR ; University of Rijeka, School of Medicine, Department of Family Medicine, Rijeka, Croatia
IVA LISICA ; Health Center of Primorje-Gorski Kotar County, Rijeka, Croatia

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 defi ned 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 barorefl ex pathway, chronic stress and associated mental states, use of some drugs, and all forms of secondary hypertension. One-fi fth 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 signifi cant effi cacy 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 specifi c forms of RAH.

Keywords

resistant arterial hypertension; family medicine; improving treatment

Hrčak ID:

179226

URI

https://hrcak.srce.hr/179226

Publication date:

6.4.2017.

Article data in other languages: croatian

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