Abstract
Hypertension is considered resistant when the blood pressure does not fall below 140/90 mmHg despite using a three-combination antihypertensive treatment including diuretics and appropriate lifestyle changes. Uncontrolled hypertension leads to subclinical organ damage with subsequent cardiovascular complications.
In clinical practice, it is important to distinguish between true resistant hypertension and pseudoresistant hypertension. Common causes of pseudoresistant hypertension are non-compliance with therapy, white coat syndrome, use of drugs and substances increasing blood pressure, undiscovered secondary hypertension, comorbidities or a wrong choice and dosage of antihypertensive drugs.
In patients with resistant hypertension, we should try to influence all the circumstances that may contribute to resistance to treatment. We should recommend lifestyle changes, elimination of interfering medication, and optimization of antihypertensive treatment.
In non-pharmacological therapy, we can recommend dietary salt restriction, restriction of alcohol consumption, weight reduction, regular physical activity, and smoking cessation. In pharmacological treatment, we prescribe multiple-combination antihypertensive therapy always with a diuretic, preferably thiazides or thiazid-like diuretics; we should not forget to add spironolactone on time.
The most common mistake in the treatment of resistant hypertension is omission or insufficient dose of diuretics, omission of spironolactone, and combination of antihypertensive drugs from the same group.