Approaches to therapy in treatment-resistant hypertension

The goal of hypertension treatment is to reduce long-term cardiovascular risk. Even a small reduction in BP can result in a significant reduction in risk. Target BP for the general population is 140/90 mm Hg. For patients with diabetes or chronic kidney disease, the target is 130/80 mm Hg. Treatment-resistant hypertension requires a multi-drug treatment strategy that targets multiple mechanisms involved in hypertension.

To improve the management of hypertension, the American Society of Hypertension and the European Society of Hypertension have each initiated a Specialist in Hypertension program.1,2 Hypertension specialists are experts in the management of hypertension and related disorders, drawn from internal medicine, cardiology, and nephrology, among other areas of practice. Hypertension specialists, as well as hypertension clinics at academic medical centers, act as a resource and referral option for primary care physicians who encounter difficult cases.

Studies indicate that patients with treatment-resistant hypertension benefit from referral to a specialist.

  • One retrospective study demonstrated that patients who were referred to a hypertension clinic for difficult-to-treat hypertension showed a decline in BP of 18/9 mm Hg
    • BP control rates increased from 18% to 52%3
  • In a separate study, 53% of patients referred to a hypertension clinic were able to achieve BP control, largely by regimen optimization and intensification4

Today, we have several current management approaches as well as emerging management approaches for patients with treatment-resistant hypertension.


  1. ASH Specialists Program, Inc. American Society of Hypertension Web site. Accessed January 31, 2012.
  2. The Hypertension Specialist Programme. European Society of Hypertension website. Accessed January 31, 2012.
  3. Bansal N, Tendler BE, White WB, Mansoor GA. Am J Hypertens. 2003;16:878-880.
  4. Garg JP, Elliott WJ, Folker A, Izhar M, Black HR. Am J Hypertens. 2005;18:619-626.

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