In patients with chronic kidney disease (CKD), resistant hypertension is associated with increased risk for adverse cardiovascular outcomes and the development of end-stage renal disease. The American College of Cardiology and the American Heart Association recently published a revised scientific statement on the definition and management of resistant hypertension. The statement codified the differences between pseudoresistant hypertension and true resistant hypertension.
Kevin S. Fay, MD, and Debbie L. Cohen, MD, reviewed the distinction and the importance of the difference to nephrologists. The review was posted online in the American Journal of Kidney Diseases [https://doi.org/10.1053/j.ajkd.2020.04.017].
Patients treated in nephrology practices commonly fail antihypertensive therapy due to difficulty in adhering to complex, multi-drug regimens. The review also includes evaluation of patients with resistant hypertension and discusses appropriate screening and diagnostic testing for the causes of secondary hypertension.
Drs. Fay and Cohen examine the management of established resistant hypertension and medication optimization, results of recent clinical trials that suggest the benefits of lifestyle modifications, and the evidence supporting routine use of mineralcorticoid receptor antagonists in this patient population. The role of diuretics in the treatment of patients with CKD is covered, as is a proposed algorithm for the diagnosis and management of patients with CKD and resistant hypertension.
The paper also touches on the current state of antihypertensive device therapies including kidney denervation and baroreceptor-directed therapies.