Question 1

What is the Meaning of Resistant Hypertension?

Accepted Answer

Resistant hypertension is clinically defined as blood pressure that remains persistently above 140/90 mmHg despite concurrent use of three or more antihypertensive agents of different classes, administered at optimal doses, one of which must be a diuretic. This definition also includes individuals whose blood pressure is controlled but requires four or more medications to achieve target values.

Question 2

What is the Context of Resistant Hypertension?

Accepted Answer

This condition operates within the complex physiological system regulating systemic arterial pressure, representing a significant challenge in cardiovascular medicine and often indicating underlying pathophysiological complexities that override standard pharmacological interventions. It signifies a breakdown in the usual homeostatic mechanisms controlling blood pressure, impacting overall cardiovascular and renal health.

Question 3

What is the Significance of Resistant Hypertension?

Accepted Answer

Its clinical significance lies in its strong association with an elevated risk of adverse cardiovascular events, including stroke, myocardial infarction, heart failure, and chronic kidney disease, necessitating a thorough diagnostic evaluation to identify secondary causes and optimize therapeutic strategies beyond conventional approaches to mitigate long-term organ damage.

Question 4

What is the Mechanism of Resistant Hypertension?

Accepted Answer

The underlying mechanisms are diverse, frequently involving volume overload, heightened sympathetic nervous system activity, activation of the renin-angiotensin-aldosterone system, obstructive sleep apnea, primary aldosteronism, and renal parenchymal disease, all contributing to persistent vascular resistance and inadequate blood pressure control despite polypharmacy.

Question 5

What is the Application of Resistant Hypertension?

Accepted Answer

Management typically involves careful assessment for medication adherence, lifestyle modifications, and exclusion of pseudo-resistance, followed by a systematic search for secondary causes of hypertension; pharmacological strategies often include mineralocorticoid receptor antagonists or other add-on agents, tailored to the individual's specific pathophysiological drivers identified during evaluation.

Question 6

What is the Metric of Resistant Hypertension?

Accepted Answer

Diagnosis primarily relies on consistently elevated office blood pressure measurements confirmed by out-of-office readings, such as ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM), which help differentiate true resistance from white-coat hypertension and assess the diurnal blood pressure profile for optimal treatment timing.

Question 7

What is the Risk of Resistant Hypertension?

Accepted Answer

Uncontrolled resistant hypertension carries substantial risks, including accelerated end-organ damage affecting the brain, heart, kidneys, and vasculature, leading to an increased incidence of cardiovascular morbidity and mortality, emphasizing the critical need for vigilant monitoring and a personalized, often multidisciplinary, treatment approach to prevent severe complications.

Resistant Hypertension

Meaning

Context

Significance

Mechanism

Application

Metric

Risk

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