This has been demonstrated in an uncontrolled study in SA and more importantly in the randomised trial of physiological individualised treatment of
resistant hypertension, as discussed above.
The trial also showed a larger blood pressure decrease for patients with higher baseline hypertension, a predictive factor of
resistant hypertension. Based on the outcome of the NEW-HOPE trial, Quantum Genomics will initiate a phase 3 pivotal trial in
resistant hypertension with Firibastat.
A 2017 meta-analysis of 5 RCTs with 662 patients evaluated the effectiveness of spironolactone (25-50 mg/d) on
resistant hypertension in patients taking 3 medications compared with a control group--placebo in 3 trials, placebo or bisoprolol (5-10 mg) in 1 trial, and an alternative treatment (candesartan 8 mg, atenolol 100 mg, or alpha methyldopa 750 mg) in 1 trial.
Other possible underlying causes of
resistant hypertension include chronic kidney disease, which impacts kidney function, and renal artery stenosis (narrowing).
Carey, M.D., from University of Virginia Health System in Charlottesville, and colleagues from the Professional/Public Education and Publications Committee of the Council on Hypertension reviewed more than 400 studies to update a previous scientific statement on the detection, evaluation, and management of
resistant hypertension.
Although renal denervation is an evolutionary treatment option for
resistant hypertension, the establishment of indications, contraindications, cost-effectiveness and potential short-, and long-term adverse effects is necessary before establishing universal protocol and guidelines of the procedure.
In up to about half the cases of apparent
resistant hypertension, people simply aren't taking their medications.
Finally, renal denervation has been advocated for the treatment of
resistant hypertension. The Symplicity 1 and 2 studies [24,25] showed very promising results.
Resistant hypertension (RH), defined as blood pressure (BP) that remains above goal in spite of the concurrent use of 3 antihypertensive agents, can be a leading risk factor for cardiovascular disease and chronic kidney disease.[sup][1] Recently, catheter-based renal denervation (RDN) has ignited expectations for the treatment of RH.
Sobotka et al., "Effects of renal denervation on sympathetic activation, blood pressure, and glucose metabolism in patients with
resistant hypertension," Frontiers in Physiology, vol.
The prevalence increases substantially to significant 83% if we consider just the subset of patients with
resistant hypertension [24].
A few studies on this aspect have mainly focused on the prevalence of secondary causes and coexisting diseases in
resistant hypertension [4,5].
