Managing Challenging Resistant Hypertension Cases

Sunday, September 27, at 12:25pm

LAS VEGAS—Resistant hypertension is an increasingly common issue for primary care practitioners to deal with, and a session this afternoon will offer information on how to approach treating the condition in a systematic way that leads to improved outcomes.
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In “Resistant Hypertension: How To Manage Challenging Cases in Primary Care,” Michael Bloch, MD, FACP, FNLA, FASH, FVM, associate professor in the department of internal medicine at the University of Nevada School of Medicine, aims to achieve objectives such as:

• Discussing the definition of resistant hypertension and its prevalence relative to other groups of patients with poorly controlled hypertension,

• Defining the work-up of patients with resistant hypertension, and

• Developing a treatment strategy, both pharmacological and non-pharmacological, for patients with resistant hypertension.

Bloch also plans to outline a diagnostic and treatment algorithm for resistant hypertension that confirms treatment resistance, excludes pseudo-resistance, identifies and reverses contributing lifestyle factors, discontinues or minimizes interfering substances, screens for secondary causes of hypertension, rationalizes and intensifies pharmacological treatment, and helps in the process of referring appropriate patients to hypertension specialists.

Ultimately, the key message Bloch plans to deliver pertains to the initiation of therapy and blood pressure goals (140/90 for most, and 150/90 for patients older than 60 with no chronic kidney disease or diabetes); choice of initial medications; early combination therapy; and other issues related to pharmacological therapy, such as less use of beta-blockers unless coronary disease or heart failure is present; and refraining from using angiotension-converting enzyme inhibitors (ACEIs) and angiotension-receptor blockers (ARBs) together.

“Resistant hypertension has a specific definition, and is far from uncommon,” says Bloch, who is also medical director of vascular care at the Renown Institute for Heart and Vascular Health.

“Rather than just talking about adding more medications, the management of resistant hypertension involves a stepwise approach to excluding ‘pseudoresistance,’ avoiding interfering substances, correcting lifestyle issues, and potentially working up secondary cause. In terms of medication adjustment, optimization of diuretic therapy is paramount.”

—Mark McGraw