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Resistant hypertension is defined as blood pressure that remains above target in spite of using three optimally dosed antihypertensive drugs of different classes, and one of the three drugs should be a diuretic. Patients whose blood pressure is controlled but requiring 4 or more drugs are also considered as resistant to treatment.
The best available evidence supports the use of low dose spironolactone as the preferred fourth antihypertensive drug if the patient's blood potassium level is low. With higher blood potassium levels, intensification of thiazide-like diuretic therapy should be considered. Renal sympathetic denervation therapy, as a device based intervention, could potentially stimulate a paradigm shift in the management of resistant hypertension.
Key words: Hypertension, diuretics, cardiovascular system, Cardiovascular Agents. Ver Tabla 1 y Tabla 2 World Health Organization. Geneva: World Health Organization Press; Roger VL et al.
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J Hypertens. Di Bona GF et al. Neural control of the kidney: past, present, and future. New therapeutic approaches to resistant hypertension. Curr Hypertens Rep; Krum H et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of- principle cohort study. Esler MD et al. Renal sympathetic denervation for treatment of drug-resistant hypertension: one-year results from the Symplicity HTN-2 randomized, controlled trial.
Catheter-based renal denervation for the treatment of patients with drug-resistant hypertension: EnligHTN 1: three-month data of a first in man study using a multi-electrode radiofrequency ablation catheter. Hering D et al. Substantial reduction in single sympathetic nerve firing after renal denervation in patients with resistant hypertension. Brinkman J et al.
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Citado por SciELO. Similares en SciELO. DeSC SUMMARY Resistant hypertension is defined as blood pressure that remains above target in spite of using three optimally dosed antihypertensive drugs of different classes, and one of the three drugs should be a diuretic. Renal sympathetic denervation therapy, as a device based intervention, could potentially stimulate a paradigm shift in the management of resistant hypertension Key words: Hypertension, diuretics, cardiovascular system, Cardiovascular Agents.
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