Clin Hypertens.
2023;29(1):30. 10.1186/s40885-023-00255-4.
Resistant hypertension: consensus document from the Korean society of hypertension
- Affiliations
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- 1Division of Cardiology, Severance Cardiovascular Hospital, Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
- 2Division of Cardiol‑ ogy, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea
- 3Division of Cardiology, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
- 4Catholic Research Institute for Intrac‑ table Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Bucheon St. Mary’s Hospital327 Sosa-Ro, Wonmi‑guGyunggi‑do, Bucheon‑si 14647, Republic of Korea
- 5Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
- 6Division of Cardiology, Depart‑ ment of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- 7Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- 8Division of Cardiol‑ ogy, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Republic of Korea
- 9Department of Internal Medicine, Kyungpook National University Hospital, Daegu, South Korea
- 10School of Medicine, Kyungpook National University, Daegu, South Korea
- 11Division of Nephrology, Department of Internal Medi‑ cine, Korea University Guro Hospital, Seoul, South Korea
- 12Division of Car‑ diology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
- 13Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
- 14Department of Family Medicine, Sever‑ ance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- 15Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- 16Hallym University, Dongtan Hospital, Gyeonggi‑do, Korea
- 17Division of Cardiology, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Korea
- 18Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
- KMID: 2552476
- DOI: http://doi.org/10.1186/s40885-023-00255-4
Abstract
- Although reports vary, the prevalence of true resistant hypertension and apparent treatment-resistant hypertension (aTRH) has been reported to be 10.3% and 14.7%, respectively. As there is a rapid increase in the prevalence of obesity, chronic kidney disease, and diabetes mellitus, factors that are associated with resistant hypertension, the prevalence of resistant hypertension is expected to rise as well. Frequently, patients with aTRH have pseudoresistant hypertension [aTRH due to white-coat uncontrolled hypertension (WUCH), drug underdosing, poor adherence, and inaccurate office blood pressure (BP) measurements]. As the prevalence of WUCH is high among patients with aTRH, the use of out-of-office BP measurements, both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), is essential to exclude WUCH. Non-adherence is especially problematic, and methods to assess adherence remain limited and often not clinically feasible. Therefore, the use of HBPM and higher utilization of single-pill fixed-dose combination treatments should be emphasized to improve drug adherence. In addition, primary aldosteronism and symptomatic obstructive sleep apnea are quite common in patients with hypertension and more so in patients with resistant hypertension. Screening for these diseases is essential, as the treatment of these secondary causes may help control BP in patients who are otherwise difficult to treat. Finally, a proper drug regimen combined with lifestyle modifications is essential to control BP in these patients.
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