Resistant Hypertension: New Approaches to a Silent Threat

Resistant hypertension is a significant health problem that cannot be controlled despite standard treatments and carries serious cardiovascular risk. Among patients being treated for hypertension, the rate of true resistant hypertension is about 10%. Before making the diagnosis, causes such as white coat hypertension, poor medication adherence, and primary aldosteronism (related to a hormone secreted by the adrenal gland that causes the kidneys to retain salt) must be ruled out. Chronic kidney disease, diabetes, obesity, older age, and sleep apnea are among the most important risk factors.

The disease is driven by complex mechanisms such as excessive release of aldosterone and cortisol from the adrenal gland, activation of the sympathetic nervous system, and sodium retention. Accurate blood pressure measurement, home monitoring, and 24-hour ambulatory blood pressure monitoring are very important for diagnosis. It is also necessary to review the medications being used and evaluate lifestyle habits.

As in the treatment of standard hypertension, the foundation of treatment is salt restriction, weight control, regular exercise, and reducing alcohol consumption. In drug therapy, mineralocorticoid antagonists such as spironolactone (which reduces the effect of aldosterone) have been found to be particularly effective. In advanced cases, interventional methods such as renal denervation (ablation of the kidney nerves) and new-generation drugs offer promising results.

In conclusion, resistant hypertension can be controlled through early diagnosis, accurate patient evaluation, and multifaceted treatment strategies.

Source

JAMA. (2026, March 27). Diagnosis and management of resistant hypertension.