Characterization of Resistant HypertensionAssociation Between Resistant Hypertension, Aldosterone, and Persistent Intravascular Volume Expansion

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Abstract
Resistant hypertension is defined as blood pressure (BP) that remains higher than the goal value despite the use of 3 antihypertensive medications, 1 ideally being a diuretic, with all agents prescribed at doses that provide optimal benefit.1,2 Although the prevalence of resistant hypertension is unknown, evidence from the National Health and Nutrition Examination Survey and from large randomized clinical studies3-6 indicates that 20% to 30% of hypertensive persons may require 3 or more antihypertensive agents to achieve treatment goals. Patients with resistant hypertension are at a disproportionately high risk for target organ damage and cardiovascular events.7 Some factors associated with poor BP control include older age, more severe hypertension, chronic kidney disease, female sex, black race, obesity, and diabetes mellitus.3,4 Although these patient characteristics are known to be associated with poorly controlled hypertension, mechanisms that underlie resistant hypertension remain poorly elucidated.