Heart Group Updates Guidelines on Resistant Hypertension

By Amy Orciari Herman

Edited by Susan Sadoughi, MD

The American Heart Association has updated its 2008 guidelines on detecting and managing resistant hypertension — defined as above-goal blood pressure (≥130/80 mm Hg) despite use of three antihypertensive drugs, or controlled BP on a four-drug regimen.

The guidelines, published in Hypertension, contain numerous practical diagnostic and clinical management tips. Among the most notable:

• Healthcare providers should regularly ask patients with resistant hypertension about their sleep patterns. Poor sleep duration and quality trigger the sympathetic and renin-angiotensin systems and, thus, can interfere with BP control.

• The role of lifestyle is emphasized as part of first-line management of resistant hypertension. Clinicians should advise patients to follow a low-sodium diet (<2400 mg/daily), lose excess weight, exercise, and get at least 6 hours of uninterrupted sleep each night.

• If BP is above goal despite an optimal lifestyle and adherence to a three-drug regimen, providers should consider switching from hydrochlorothiazide to chlorthalidone or indapamide. If BP is still high after that, spironolactone may be considered as a fourth drug.