Refractory hypertension

náhled|200px|Nespolupráce pacienta („non-compliance“) Refractory hypertension (synonym Resistant hypertension, RH) is defined as blood pressure exceeding 140/90 mmHg – despite long enough treatment with triple combinations of antihypertensives of different classes, one of which is a diuretic.

* Currently, the definitions of refractory and resistant hypertension are different: resistant hypertension resists combination therapy of three groups of antihypertensives, one of which is a diuretic, while refractory hypertension resists combination of even five different groups of antihypertensives.


 * Refractory hypertension affects 5–30% of patients with hypertension.

Risks
Patients with refractory hypertension have a higher risk of (compared to compensated hypertension):


 * myocardial infarction;
 * stroke;
 * dissecting aortic aneurysm;
 * renal failure;
 * congestive heart failure.

Causes
The causes of refractory hypertension include:


 * secondary hypertension (must be treated causally);
 * inadequate antihypertensive treatment (inappropriate combination of antihypertensive drugs, inappropriate dosage);
 * associated diseases;
 * concomitant use of nonsteroidal antirheumatic drugs;
 * patient non-cooperation (patient does not respect the recommended doses and / or intervals; refuses to influence an unhealthy lifestyle: smoking, alcohol, salt, physical activity).

Resources

 * HOLAJ, Robert. Kardiologický kroužek. III. interní klinika VFN a 1. LF UK v Praze, 2009.