Head of the Center for Cardiovascular Prevention, Charles University Medical School and Thomayer Hospital, Prague, Czech Republic.
ESH Educational Activities Committee Secretary and Chairperson of the European Society of Cardiology Working Group “Hypertension and the Heart”.
The problem of resistant hypertension is the identification of truly resistant hypertensive patients.
Most of the patients referred to as having resistant hypertension have, in fact, pseudo-resistant hypertension.
The most frequent cause of pseudo-resistant hypertension is poor patient adherence.
Another frequent cause of pseudo-resistant hypertension is suboptimal dosing of antihypertensive agents or inappropriate combinations.
Clinical inertia (defined as the conscious decision by a clinician not to adequately treat a condition), contributes to pseudo-resistant hypertension.
There is no single definition of resistant hypertension; the one most frequently used is the failure to achieve goal blood pressure when the patient adheres to maximum tolerated doses of three antihypertensive drugs including a diuretic.
However, it might be more appropriate to insist on four antihypertensive drugs including a diuretic and, if possible, an antialdosterone drug.