ArticleJournal of clinical hypertension (Greenwich, Conn.)2012
Refractory hypertension: definition, prevalence, and patient characteristics.
Article in Journal of clinical hypertension (Greenwich, Conn.), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 84 papers, 2 of them syntheses that pooled it.
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Who cites it
84 citing papers in PubMed, 2 syntheses or guidelines pooled it, 196 citations in OpenAlex.
- Refractory Hypertension: a Narrative Systematic Review with Emphasis on Prognosis.Current hypertension reports · 2022Pooled it
- I Brazilian guideline on hypertension in dialysis of the Brazilian Society of Nephrology.Jornal brasileiro de nefrologiaGuideline
- Effect of low-dose spironolactone on resistant hypertension in type 2 diabetes mellitus: a randomized controlled trial in a sub-Saharan African population.BMC research notes · 2016Trial
- Effect of spironolactone in resistant arterial hypertension: a randomized, double-blind, placebo-controlled trial (ASPIRANT-EXT).Medicine · 2014Trial
- Effects of spironolactone on dialysis patients with refractory hypertension: a randomized controlled study.Journal of clinical hypertension (Greenwich, Conn.) · 2014Trial
- Characteristics, drug combinations and dosages of primary care patients with uncontrolled ambulatory blood pressure and high medication adherence.Journal of the American Society of Hypertension : JASHTrial
- Resistant Hypertension: Integration of Novel Agents and Interventional Approaches in Clinical Practice.Reviews in cardiovascular medicine · 2026Review
- Article
- A Review of the Risk Factors and Management of Refractory Hypertension: The Role of Carotid Sinus Stimulation and Renal Nerve Denervation.Journal of community hospital internal medicine perspectives · 2024Review
- Cellular Senescence in Cardiovascular Diseases: From Pathogenesis to Therapeutic Challenges.Journal of cardiovascular development and disease · 2023Review
- Apparent treatment-resistant hypertension associated lifetime cardiovascular risk in a longitudinal national registry.European journal of preventive cardiology · 2023Article
- When blood pressure refuses to budge: exploring the complexity of resistant hypertension.Frontiers in cardiovascular medicine · 2023Review
- An Update on Refractory Hypertension.Current hypertension reports · 2022Review
- Pathophysiology and genetics of salt-sensitive hypertension.Frontiers in physiology · 2022Review
- Insight on Efficacy of Renal Artery Denervation for Refractory Hypertension with Chronic Kidney Diseases: A Long-Term Follow-Up of 24-Hour Ambulatory Blood Pressure.Journal of interventional cardiology · 2022Article
- Prevalence and clinical profile of refractory hypertension in a large cohort of patients with resistant hypertension.Journal of human hypertension · 2021Article
- Hypertension in Chronic Kidney Disease (CKD): Diagnosis, Classification, and Therapeutic Targets.American journal of hypertension · 2021Article
- Hypertension: Do Inflammation and Immunity Hold the Key to Solving this Epidemic?Circulation research · 2021Review
- Refractory hypertension: what do we know so far?Journal of human hypertension · 2021Article
- β-Arrestin-Biased Agonist Targeting the Brain ATHypertension (Dallas, Tex. : 1979) · 2021Article
24 more citing papers are in PubMed but not listed here.
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
Abstract
Among patients with resistant hypertension (RHTN), there are those whose blood pressure (BP) remains uncontrolled in spite of maximal medical therapy. This retrospective analysis aims to characterize these patients with refractory hypertension. Refractory hypertension was defined as BP that remained uncontrolled after ≥3 visits to a hypertension clinic within a minimum 6-month follow-up period. Of the 304 patients referred for RHTN, 29 (9.5%) remained refractory to treatment. Patients with refractory hypertension and those with controlled RHTN had similar aldosterone levels and plasma renin activity (PRA). Patients with refractory hypertension had higher baseline BP (175±23/97±15 mm Hg vs 158±25/89±15 mm Hg; P=.001/.005) and heart rate, and higher rates of prior stroke and congestive heart failure. During follow-up, the BP of patients with refractory hypertension remained uncontrolled (168.4±14.8/93.8±17.7 mm Hg) in spite of use of an average of 6 antihypertensive medications, while those of patients with controlled RHTN decreased to 129.3±11.2/77.6±10.8 mm Hg. Spironolactone reduced the BP by 12.9±17.8/6.6±13.7 mm Hg in patients with refractory hypertension and by 24.1±16.7/9.2±12.0 mm Hg in patients with controlled RHTN. In patients with RHTN, approximately 10% remain refractory to treatment. Similar aldosterone and PRA levels and a diminished response to spironolactone suggest that aldosterone excess does not explain the treatment failure.
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