Hipertensión arterial refractaria

Arterial hypertension is defined as resistant or refractory to antihypertensive treatment when adequate control of the blood pressure below 140/90 mmHg or values even lower in high risk hypertensive subjects is not obtained by antihypertensive treatment with 3 or more drugs, including a diuretic, at adequate doses. In most of the cases, blood pressure remains uncontrolled due to lack of control of systolic blood pressure. In the first place, lack of compliance of antihypertensive medication and the existence of an isolated clinically resistant hypertension, by ambulatory blood pressure monitoring must be stressed. On the other hand, factors associated to resistant arterial hypertension, such as advanced age, obesity, excessive intake of salt and presence of sleep apnea syndrome or of secondary arterial hypertension have been described. Patients with resistant arterial hypertension have greater prevalence of lesions of target organs or of associated clinical complications, but the prognosis of hypertensive subjects is more related with the arterial pressure obtained during treatment. Thus, treatment of these patients should include a therapeutic plan with multiple drugs. Recent studies have shown that control of blood pressure may improve with aldosterone antagonists, even in the absence of primary hyperaldosteronism.