Uncontrolled and resistant arterial hypertension: prevalence, methods of modification of therapy

The management of patients with uncontrolled arterial hypertension in real clinical practice remains a difficult task, despite the impressive arsenal antihypertensive drugs. In most cases, correction medical therapy and lifestyle modification this group can achieve success treatment, but some target levels blood pressure (AH) cannot be achieved. Aim. To assess incidence true resistant hypertension, to identify main causes determine methods therapy. M aterials methods. study included 70 who received previously. All underwent office measurement at initial visit after therapy, 24-hour monitoring (ABPM) was performed. Correction prescription standard three-component regimen «RAAS blocker + calcium antagonist thiazide diuretic». case failure BP levels, aldosterone/renin carried out exclude primary hyperaldosteronism (PHA). all patients, body mass index (BMI) calculated, echocardiography performed organ damage, complete count, biochemical tests were (to detect existing kidney damage). Results. 86% achieved through (weight loss) previous 24% subjects, low adherence (non-compliance) due polypharmacy revealed, connection which recommended switch fixed combinations drugs, made it possible significantly reduce below 140/90 mm Hg. according results ABPM patients. 8% amlodipine/lercanidipine replaced long-acting nifedipine, also led decrease (−5,5 Hg mean ABPM). two diagnosis PHA established, tumor form disease excluded using computed tomography adrenal glands, treatment aldosterone antagonists prescribed. 10% «Resistant hypertension» confirmed, spironolactone doses (25-50 mg), doxazosin 1 mg, moxonidine 0,4 bisoprolol 5 mg sequentially added treatment. Spironolactone showed similar efficacy (−7,1 mmHg −6,9 BP, respectively), less effective (−4,8 −5,2 mmHg, respectively). addition or did not lead achievement level, loop diuretic (furosemide 40 mg) C on c lusion. among 10%. if is impossible values pressure, provided that correctly prescribed, necessary symptomatic particular, PHA. confirmation RAH, prescribe (spironolactone) small doses, acceptable.