According to recent experience there is an unexpected high prevalence of treatment resistance in hypertension, i.e. an inefficiency of even complex treatment modalities, increasing the need for multi-drug regimens. Mostly, this applies to systolic hypertension which over the years was found to cause at least as much target organ damage as diastolic. In view of the high prevalence of hypertension, such resistance may be a rising concern. This might not only be due to inefficiency of drugs, but also to low blood pressure levels as treatment goals and to increasing patient age with more systolic hypertension. Over the past few years, some new evidence has accumulated that will contribute to a break-down of the complex of treatment resistance into several categories of both primary and secondary hypertension, the most important may be the high frequency of white-coat hypertension, aldosteronism, low-renin hypertension and adiposity. In turn, the new evidence may lead to effective treatment for nearly every patient suffering therapy resistance. Such efficiency is all the more wanted since blood pressures in these patients are often severe and fraught with serious complications.
Keywords: Aldosteronism, amiloride, guidelines, low-renin, randomized, refractory, trials
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