Resistant Hypertension
2012; Lippincott Williams & Wilkins; Volume: 125; Issue: 13 Linguagem: Finlandês
10.1161/circulationaha.112.097345
ISSN1524-4539
AutoresEduardo Pimenta, David A. Calhoun,
Tópico(s)Sodium Intake and Health
ResumoHomeCirculationVol. 125, No. 13Resistant Hypertension Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBResistant HypertensionIncidence, Prevalence, and Prognosis Eduardo Pimenta, MD and David A. Calhoun, MD Eduardo PimentaEduardo Pimenta From the Endocrine Hypertension Research Center and Clinical Center of Research Excellence in Cardiovascular Disease and Metabolic Disorders, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia (E.P.); and Vascular Biology and Hypertension Program, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL (D.A.C.). and David A. CalhounDavid A. Calhoun From the Endocrine Hypertension Research Center and Clinical Center of Research Excellence in Cardiovascular Disease and Metabolic Disorders, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia (E.P.); and Vascular Biology and Hypertension Program, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL (D.A.C.). Originally published29 Feb 2012https://doi.org/10.1161/CIRCULATIONAHA.112.097345Circulation. 2012;125:1594–1596Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2012: Previous Version 1 Since the publication of the American Heart Association (AHA) Scientific Statement on the Evaluation and Treatment of Resistant Hypertension in 2008, there has been growing clinical and research interest in the epidemiology, pathophysiology, and therapeutic management of resistant hypertension.1 Highlighted, however, by the authors of that AHA Scientific Statement were important deficiencies in our knowledge and understanding of resistant hypertension. Specifically commented on was the lack or even absence of data on the incidence, prevalence, and prognosis of resistant hypertension.Article see p 1635Several recent publications have provided insight into the prevalence of resistant hypertension. In the current issue of Circulation, Daugherty et al provide important information on the incidence and prognosis.2 Combined, these publications have made substantial progress in addressing deficiencies in the epidemiology of resistant hypertension.IncidenceThe analysis of Daugherty et al clearly represents the most rigorous, if not the first determination, of the incidence of resistant hypertension based on patients presenting with incident hypertension.2 Using patient data collected over a 4-year period in the Kaiser Permanente Colorado and Northern California healthcare systems, the authors identified 200 000 patients who were started on antihypertensive therapy for newly diagnosed hypertension. During follow-up, ≈21% were eventually prescribed ≥3 medications. Control or lack of blood pressure control was determined as close to 1 year as possible after the third antihypertensive medication was prescribed. After excluding patients who were nonadherent, on the basis of a 3) to control their blood pressure.PrevalenceRecently, the National Health and Nutrition Examination Survey (NHANES) dataset has been used to estimate the prevalence of resistant hypertension. Using data collected from 2003 through 2008, Persell estimated that the prevalence of resistant hypertension was 8.9% of all US adults with hypertension and, perhaps more meaningfully, 12.8% of all US adults being treated for hypertension.3 Looking at trends in blood pressure control as measured by NHANES, Egan et al found that the estimated prevalence of resistant hypertension has been increasing progressively over the last several decades.4 Between 1988 and 1994, the estimated prevalence of resistant hypertension was 5.5% of all US hypertensive adults. Between 1999 and 2004, the rate was 8.5%, and most recently, between 2005 and 2008, the estimated prevalence was 11.8%. With an estimated 76 million adult Americans with hypertension, a prevalence rate of almost 12% would translate into an estimated 9 million Americans with resistant hypertension.5Spanish investigators, on the basis of an analysis of 68 000 patients being followed by primary care physicians and specialists and who had been included in a registry of ambulatory blood pressure monitoring, found the prevalence of resistant hypertension to be 14.8% of treated patients on the basis of AHA criteria.6 White coat–resistant hypertension, defined as an elevated clinic blood pressure (>140/90 mm Hg) but controlled 24-hour ambulatory blood pressure ( 140/90 mm Hg on ≥3 medications).7 This extraordinarily high occurrence of resistant hypertension was not unique to ASCOT. In the Antihypertensive and Lipid-Lowering and Treatment to Prevent Heart Attack Trial (ALLHAT), after ≈5 years of follow-up, 34% of participants remained uncontrolled on an average of 2 medications and 27% were receiving ≥3 medications.8 Overall, 49% of ALLHAT participants were controlled on 1 or 2 medications, meaning that ≈50% of participants would have needed ≥3 blood pressure medications to achieve the goal blood pressure of <140/90 mm Hg. More recently, in the Avoiding Cardiovascular Events in Patients Living with Systolic Hypertension (ACCOMPLISH) study, 25% to 28% of subjects remained uncontrolled during the course of the study in spite of intensive treatment escalation.9On the one hand, clinical trials such as ASCOT, ALLHAT, and ACCOMPLISH likely provide the best estimate of the prevalence of true treatment resistance because they were forced-titration studies: All medications were provided at no charge and medication adherence was closely monitored. These study features, designed to enhance blood pressure control, highlight that one of the biggest limitations of the observational studies, such as NHANES, is that a large proportion of participants remain undertreated (ie, uncontrolled on 1–2 antihypertensive medications). For example, in Persell's analysis of the NHANES data from 2003 to 2008, 28% of medication-treated hypertensive adults remained uncontrolled on 2 antihypertensive agents.3 With appropriate intensification of treatment, an unknown percentage of these participants would continue to be uncontrolled on 3 medications and hence properly designated as having resistant hypertension. The clinical trials, at least in design, would have minimized (although not eliminated) this clinical inertia and therefore may more accurately reflect the degree of true treatment resistance.On the other hand, clinical trials likely overinflate the apparent degree of treatment resistance because use of specific medication combinations may have been restricted per protocol, and study enrollment was often limited to older subjects at high cardiovascular risk, which tends to enrich the study cohort with subjects more likely to be resistant to treatment. Fully reconciling the opposing effects of the different study designs is of course impossible, but with consideration of both the earlier clinical trial results and the more recent observational findings, the prevalence of resistant hypertension can be estimated with a higher level of confidence at between 15% to 30% of treated hypertensive patients.The current analysis by Daugherty et al does not report the prevalence of resistant hypertension in relation to all treated hypertensive patients. Such an assessment would have strengthened the current estimates of prevalence because it would have allowed for exclusion of patients who did not adhere to their prescribed medications. Lack of this correction remains an important limitation of current determinations of prevalence.PrognosisPerhaps the most important and most intriguing finding of Daugherty et al is the considerably increased cardiovascular risk manifest in subjects with resistant hypertension. Important, because it is the first study to determine outcomes on the basis of a longitudinal assessment of a large cohort of subjects with rigorously defined resistant hypertension. Multiple prior cross-sectional assessments of subjects with resistant hypertension compared with subjects without resistant hypertension have consistently indicated in the former an increased frequency of cardiovascular complications, including myocardial infarction, stroke, congestive heart failure, and chronic kidney disease.3,4,6 Although the study by Daugherty et al was not done prospectively, it analyzed longitudinal data collected over a 5-year period to demonstrate a 50% increase in cardiovascular events (largely attributable to development of chronic kidney disease) in patients with resistant hypertension compared with patients whose blood pressure had been controlled on 3 medications.2 Compared with all subjects being newly treated for hypertension, the risk of cardiovascular events in patients diagnosed with resistant hypertension was increased by 2 fold.These findings are intriguing in that the difference in cardiovascular event rates occurred even though the duration of the patients' hypertension should have been the same (only subjects with incident hypertension during the analysis period were included) and, presumably, the difference in blood pressure levels would have been minimized by application of system-wide treatment protocols. Differences in complication rates between patients with and without resistant hypertension have been attributed to presumed differences in accumulated blood pressure burden secondary to differences in duration and severity of hypertension. The current analysis, in minimizing those differences in blood pressure burden (but not eliminating them, given that blood pressure levels were higher in the resistant hypertensive patients when first starting antihypertensive treatment), suggests that a factor separate from blood pressure burden may be accelerating cardiovascular disease progression in patients with resistant hypertension.It is tempting to speculate that one contributing factor to the greater frequency of cardiovascular complications observed in patients with resistant hypertension may be excess aldosterone. Multiple studies have shown hyperaldosteronism to be common in patients with resistant hypertension.10,11 Additional studies have indicated that, when combined with high dietary salt intake, aldosterone is an important mediator of cardiovascular disease severity, including resistance to antihypertensive treatment, chronic kidney disease, and left ventricular hypertrophy.12–15 If aldosterone contributes to the higher risk of cardiovascular disease, preferential use of a mineralocorticoid receptor antagonist for treatment of resistant hypertension may provide, beyond its well-recognized antihypertensive effect, specific benefit in terms of blunting the increased cardiovascular risk of having resistant hypertension. Daugherty et al were not in a position to assess this possibility because the use of mineralocorticoid receptor antagonists was extremely minimal in their cohort. Such an assessment, however, if possible in future analyses, would serve to guide optimal management of resistant hypertension while testing a potentially important pathophysiological mechanism of heightened cardiovascular risk in patients with resistant hypertension.Sources of FundingThis work was supported by National Institutes of Health grant R01HL075614 (to Dr Calhoun) and National Institutes of Health National Center for Advancing Translational Sciences grant 5UL1 RR025777.DisclosuresDr Calhoun has been a consultant, served on the advisory board, or received research grants from Novartis and Merck. Dr Pimenta has been a consultant for Novartis and Merck.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to Eduardo Pimenta, MD, Hypertension Unit, Princess Alexandra Hospital, Ipswich Road, 5th Floor, Brisbane, QLD, 4102, Australia. E-mail e.[email protected]edu.auReferences1. Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, White A, Cushman WC, White WB, Sica D, Ferdinand K, Giles TD, Falkner B, Carey RM. American Heart Association Scientific Statement. Resistant hypertension: diagnosis, evaluation, and treatment. Hypertension. 2008; 51: 1403–1419.LinkGoogle Scholar2. Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, O'Connor PJ, Selby JV, Ho PM. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012; 125: 1635–1642.LinkGoogle Scholar3. Persell SD. Prevalence of resistant hypertension in the United States, 2003–2008. Hypertension. 2011; 57: 1076–1080.LinkGoogle Scholar4. Egan BM, Zhao Y, Axon RN, Brzezinski WA, Ferdinand KC. Uncontrolled and apparent treatment resistant hypertension in the United States, 1988–2008. Circulation. 2011; 124: 1046–1058.LinkGoogle Scholar5. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation. 2011; 123: e18–e209.LinkGoogle Scholar6. de la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Amario P, Oliveras A, Ruilope LM. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension. 2011; 57: 898–902.LinkGoogle Scholar7. Gupta AK, Nasothimiou EG, Chane CL, Sever PS, Dahlöf , Poulter NRon behalf of the ASCOT investigators. Baseline predictors of resistant hypertension in the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT): a risk score to identify those at high-risk. J Hypertens. 2011; 29: 2004–2013.CrossrefMedlineGoogle Scholar8. Cushman WC, Ford CE, Cutler JA, Margolis KL, Davis BR, Grimm RH, Black HR, Hamilton BP, Holland J, Nwachuku C, Papademetriou V, Probstfield J, Wright JT, Alderman MH, Weiss RJ, Piller L, Bettencourt J, Walsh SMfor the ALLHAT Collaborative Research Group. Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering and Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens. 2002; 4: 393–404.CrossrefGoogle Scholar9. Jamerson K, Weber MA, Bakris GL, Dahlöf B, Pitt B, Shi V, Hester A, Gupte J, Gatln M, Velazquez EJfor the ACCOMPLISH trial investigators. Benazepril plus amlodipine or hydrochlorthiazide for hypertension in high-risk patients. N Engl J Med. 2008; 359: 2417–2428.CrossrefMedlineGoogle Scholar10. Calhoun DA, Nishizaka MK, Zaman MA, Thakkar RB, Weissman P. High prevalence of primary aldosteronism among black and white subjects with resistant hypertension. Hypertension. 2002; 40: 892–896.LinkGoogle Scholar11. Eide IK, Torjesen PA, Drolsum A, Babovic A, Lilledahl NP. Low-renin status in therapy-resistant hypertension: a clue to efficient treatment. J Hypertens. 2004; 22: 2217–2226.CrossrefMedlineGoogle Scholar12. Pimenta E, Gaddam KK, Oparil S, Aban I, Husain S, Dell'Italia LJ, Calhoun DA. Effects of dietary sodium restriction on blood pressure in subjects with resistant hypertension: results from a randomized trial. Hypertension. 2009; 54: 475–481.LinkGoogle Scholar13. Pimenta E, Gaddam KK, Pratt-Ubunama MNK, Nishizaka MK, Aban I, Oparil S, Calhoun DA. Relation of dietary salt and aldosterone to urinary protein excretion in subjects with resistant hypertension. Hypertension. 2008; 51: 339–344.LinkGoogle Scholar14. Jin Y, Kuznetsova T, Maillard M, Richart T, Thijs L, Bochud M, Heregods MC, Burnier M, Fagard R, Staessen JA. Independent relations of left ventricular structure with the 24-hour urinary excretion of sodium and aldosterone. Hypertension. 2009; 54: 489–495.LinkGoogle Scholar15. Pimenta E, Gordon RD, Ahmed AH, Cowley D, Leano R, Marwick TH, Stowasser M. Cardiac dimensions are largely determined by dietary salt in patients with primary aldosteronism: results of a case-control study. J Clin Endocrinol Metab. 2011; 96: 2813–2820.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Yamamoto E, Sueta D and Tsujita K (2022) Renal denervation in resistant hypertension: a review of clinical trials and future perspectives, Cardiovascular Intervention and Therapeutics, 10.1007/s12928-022-00854-2, 37:3, (450-457), Online publication date: 1-Jul-2022. Brown J, Yazdi F, Jodari-Karimi M, Owen J and Reisin E (2022) Obstructive Sleep Apnea and Hypertension: Updates to a Critical Relationship, Current Hypertension Reports, 10.1007/s11906-022-01181-w, 24:6, (173-184), Online publication date: 1-Jun-2022. Li W, Gong M, Yu Q, Liu R, Chen K, Lv W, Yao F, Xu Z, Xu Y, Song W and Jiang Y (2022) Efficacy of angiotensin receptor neprilysin inhibitor in Asian patients with refractory hypertension, The Journal of Clinical Hypertension, 10.1111/jch.14454, 24:4, (449-456), Online publication date: 1-Apr-2022. Costa G, Delgado-Silva J, Monteiro E, Campos D and Gonçalves L (2022) Renal sympathetic denervation in resistant hypertension: The association between vitamin D and positive early response in systolic blood pressure, Revista Portuguesa de Cardiologia, 10.1016/j.repc.2021.02.025, 41:4, (311-320), Online publication date: 1-Apr-2022. Del Punta L, De Biase N, Balletti A, Filidei F, Pieroni A, Armenia S, Mengozzi A, Mazzola M, Di Fiore V, Dini F, Rosada J, Virdis A, Taddei S, Pugliese N and Masi S (2022) Arterial Hypertension and Cardiopulmonary Function: The Value of a Combined Cardiopulmonary and Echocardiography Stress Test, High Blood Pressure & Cardiovascular Prevention, 10.1007/s40292-021-00494-2, 29:2, (145-154), Online publication date: 1-Mar-2022. Parcero-Valdés J and Díaz-y-Díaz E (2022) Impacto de las terapias alternativas en el tratamiento de la hipertensión arterial sistémica resistente, Cardiovascular and Metabolic Science, 10.35366/105189, 33:S3, (233-237), . Gaudieri V, Mannarino T, Zampella E, Assante R, D'Antonio A, Nappi C, Cantoni V, Green R, Petretta M, Arumugam P, Cuocolo A and Acampa W (2021) Prognostic value of coronary vascular dysfunction assessed by rubidium-82 PET/CT imaging in patients with resistant hypertension without overt coronary artery disease, European Journal of Nuclear Medicine and Molecular Imaging, 10.1007/s00259-021-05239-w, 48:10, (3162-3171), Online publication date: 1-Sep-2021. Işık F, Çap M, Akyüz A, Bilge Ö, Aslan B, İnci Ü, Kaya İ, Taştan E, Okşul M, Çap N, Karagöz A and Baysal E (2021) The effect of resistant hypertension on in-hospital mortality in patients hospitalized with COVID-19, Journal of Human Hypertension, 10.1038/s41371-021-00591-8 El Karbane M, Benchekroun Y, Abousalih F, Bennani I, Azougagh M, Saffaj T and Bouatia M (2020) Development and Validation of a UPLC-DAD Method for the Simultaneous Quantification of Eight Antihypertensive Drugs in the Pharmaceutical Matrix, Journal of AOAC INTERNATIONAL, 10.1093/jaoacint/qsaa165, 104:3, (562-570), Online publication date: 12-Jun-2021. Lang K, Van Iterson E and Laffin L (2020) Contemporary Strategies to Manage High Blood Pressure in Patients with Coexistent Resistant Hypertension and Heart Failure With Reduced Ejection Fraction, Cardiology and Therapy, 10.1007/s40119-020-00203-5, 10:1, (9-25), Online publication date: 1-Jun-2021. Asirvatham-Jeyaraj N, Gauthier M, Banek C, Ramesh A, Garver H, Fink G and Osborn J (2021) Renal Denervation and Celiac Ganglionectomy Decrease Mean Arterial Pressure Similarly in Genetically Hypertensive Schlager (BPH/2J) Mice, Hypertension, 77:2, (519-528), Online publication date: 1-Feb-2021. Paudel P, McDonald F and Fronius M (2021) The δ subunit of epithelial sodium channel in humans—a potential player in vascular physiology , American Journal of Physiology-Heart and Circulatory Physiology, 10.1152/ajpheart.00800.2020, 320:2, (H487-H493), Online publication date: 1-Feb-2021. Tsujimoto T and Kajio H (2020) Spironolactone Use and Improved Outcomes in Patients With Heart Failure With Preserved Ejection Fraction With Resistant Hypertension, Journal of the American Heart Association, 9:23, Online publication date: 1-Dec-2020. Song W, Baik J, Choi E, Lee H, Kim H, Park S and Jeong C (2020) Quantitative analysis of renal arterial variations affecting the eligibility of catheter-based renal denervation using multi-detector computed tomography angiography, Scientific Reports, 10.1038/s41598-020-76812-w, 10:1, Online publication date: 1-Dec-2020. Raina R, Mahajan Z, Sharma A, Chakraborty R, Mahajan S, Sethi S, Kapur G and Kaelber D (2020) Hypertensive Crisis in Pediatric Patients: An Overview, Frontiers in Pediatrics, 10.3389/fped.2020.588911, 8 Lithovius R, Harjutsalo V, Mutter S, Gordin D, Forsblom C and Groop P (2020) Resistant Hypertension and Risk of Adverse Events in Individuals With Type 1 Diabetes: A Nationwide Prospective Study, Diabetes Care, 10.2337/dc20-0170, 43:8, (1885-1892), Online publication date: 1-Aug-2020. Gallacher P, Farrah T, Dominiczak A, Touyz R, Adamczak M, Barigou M, Zoghby Z, Hiremath S and Dhaun N (2020) Resistant Hypertension in a Dialysis Patient, Hypertension, 76:2, (278-287), Online publication date: 1-Aug-2020. Durand H, Casey M, Glynn L, Hayes P, Murphy A and Molloy G (2019) A qualitative comparison of high and low adherers with apparent treatment-resistant hypertension, Psychology, Health & Medicine, 10.1080/13548506.2019.1619788, 25:1, (64-77), Online publication date: 2-Jan-2020. Cardoso C, Leite N, Bacan G, Ataíde D, Gorgonio L and Salles G (2019) Prognostic Importance of Resistant Hypertension in Patients With Type 2 Diabetes: The Rio de Janeiro Type 2 Diabetes Cohort Study, Diabetes Care, 10.2337/dc19-1534, 43:1, (219-227), Online publication date: 1-Jan-2020. Gupta A, Prince M, Bob-Manuel T and Jenkins J (2020) Renal denervation: Alternative treatment options for hypertension?, Progress in Cardiovascular Diseases, 10.1016/j.pcad.2019.12.007, 63:1, (51-57), Online publication date: 1-Jan-2020. Prince M, Gupta A, Bob-Manuel T and Tafur J (2020) Renal revascularization in resistant hypertension, Progress in Cardiovascular Diseases, 10.1016/j.pcad.2019.12.001, 63:1, (58-63), Online publication date: 1-Jan-2020. Solini A, Penno G, Orsi E, Bonora E, Fondelli C, Trevisan R, Vedovato M, Cavalot F, Lamacchia O, Baroni M, Nicolucci A and Pugliese G (2019) Is resistant hypertension an independent predictor of all-cause mortality in individuals with type 2 diabetes? A prospective cohort study, BMC Medicine, 10.1186/s12916-019-1313-x, 17:1, Online publication date: 1-Dec-2019. Tanaka S, Ninomiya T, Hiyamuta H, Taniguchi M, Tokumoto M, Masutani K, Ooboshi H, Nakano T, Tsuruya K and Kitazono T (2019) Apparent Treatment-Resistant Hypertension and Cardiovascular Risk in Hemodialysis Patients: Ten-Year Outcomes of the Q-Cohort Study, Scientific Reports, 10.1038/s41598-018-37961-1, 9:1, Online publication date: 1-Dec-2019. Podzolkov V, Bragina A and Osadchiy K (2019) Resistant Hypertension: Questions and Contemporary Answers, Rational Pharmacotherapy in Cardiology, 10.20996/1819-6446-2019-15-4-568-577, 15:4, (568-577) Schmidt M, Roessner F, Berger M, Tesche C, Rieber J, Bauner K, Huber A, Rummeny E, Hoffmann E and Ebersberger U (2019) Renal Sympathetic Denervation, Journal of Thoracic Imaging, 10.1097/RTI.0000000000000399, 34:5, (338-344), Online publication date: 1-Sep-2019. Keck M, Hmazzou R and Llorens-Cortes C (2019) Orally Active Aminopeptidase A Inhibitor Prodrugs: Current State and Future Directions, Current Hypertension Reports, 10.1007/s11906-019-0957-4, 21:7, Online publication date: 1-Jul-2019. Keck M, De Almeida H, Compère D, Inguimbert N, Flahault A, Balavoine F, Roques B and Llorens-Cortes C (2019) NI956/QGC006, a Potent Orally Active, Brain-Penetrating Aminopeptidase A Inhibitor for Treating Hypertension, Hypertension, 73:6, (1300-1307), Online publication date: 1-Jun-2019. Berukstis A, Navickas R, Neverauskaite-Piliponiene G, Ryliskyte L, Misiura J, Vajauskas D, Misonis N and Laucevicius A (2019) Arterial Destiffening Starts Early after Renal Artery Denervation, International Journal of Hypertension, 10.1155/2019/3845690, 2019, (1-7), Online publication date: 3-Mar-2019. Valentine D, Lord A, Torres J, Frontera J, Ishida K, Czeisler B, Lee F, Rosenthal J, Calahan T and Lewis A (2019) How Does Preexisting Hypertension Affect Patients with Intracerebral Hemorrhage?, Journal of Stroke and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2018.11.023, 28:3, (782-788), Online publication date: 1-Mar-2019. Dilcy M, Rosileide Z, Francisco d, Sabrina J and Alfredo D (2019) Improving blood pressure control in patients with pseudoresistant hypertension A pilot randomized trial, African Journal of Pharmacy and Pharmacology, 10.5897/AJPP2018.4990, 13:1, (1-5) Narayan P and Kumar A (2019) Role of Physical Activity, Exercise, and Cardiorespiratory Fitness in the Management of Resistant Hypertension Cardiorespiratory Fitness in Cardiometabolic Diseases, 10.1007/978-3-030-04816-7_9, (169-179), . Tafur J and White C (2018) Severe Renal Artery Stenosis Endovascular Interventions, 10.1002/9781119283539.ch11, (121-134), Online publication date: 3-Dec-2018. Hayes P, Kielty H, Casey M, Glynn L, Molloy G, Durand H, Newell J and Murphy A (2018) Prognosis of patients with apparent treatment-resistant hypertension—a feasibility study, Pilot and Feasibility Studies, 10.1186/s40814-018-0232-5, 4:1, Online publication date: 1-Dec-2018. Pham G, Wang L and Mathis K (2018) Pharmacological potentiation of the efferent vagus nerve attenuates blood pressure and renal injury in a murine model of systemic lupus erythematosus, American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 10.1152/ajpregu.00362.2017, 315:6, (R1261-R1271), Online publication date: 1-Dec-2018. Lim R, Chen W, Choong D, Damalerio M and Cheng M (2018) Development of Three Dimensional Roll-up Polymer-Si Structure for Nerve Ablation Catheter 2018 IEEE 20th Electronics Packaging Technology Conference (EPTC), 10.1109/EPTC.2018.8654386, 978-1-5386-7668-4, (454-458) Carey R, Calhoun D, Bakris G, Brook R, Daugherty S, Dennison-Himmelfarb C, Egan B, Flack J, Gidding S, Judd E, Lackland D, Laffer C, Newton-Cheh C, Smith S, Taler S, Textor S, Turan T and White W (2018) Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association, Hypertension, 72:5, (e53-e90), Online publication date: 1-Nov-2018. Avataneo V, De Nicolò A, Rabbia F, Perlo E, Burrello J, Berra E, Pappaccogli M, Cusato J, D'Avolio A, Di Perri G and Veglio F (2018) Therapeutic drug monitoring‐guided definition of adherence profiles in resistant hypertension and identification of predictors of poor adherence, British Journal of Clinical Pharmacology, 10.1111/bcp.13706, 84:11, (2535-2543), Online publication date: 1-Nov-2018. Avataneo V, De Nicolò A, Rabbia F, Sciandra M, Tosello F, Cusato J, Perlo E, Fatiguso G, Allegra S, Favata F, Mulatero P, Veglio F, Di Perri G and D'Avolio A (2018) A simple UHPLC-PDA method with a fast dilute-and-shot sample preparation for the quantification of canrenone and its prodrug spironolactone in human urine samples, Journal of Pharmacological and Toxicological Methods, 10.1016/j.vascn.20
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