What are the current challenges and issues in resistant hypertension? Professor Sverre Kjeldsend, Oslo University Hospital Ullevaal, Norway, talks to Cardio Debate about the future of research into resistant hypertension during the ESC 2015 Congress in London, UK.
What is the current status regarding the diagnosis of resistant hypertension?
The main problem with diagnosis is to find out whether people are taking their antihypertensive drugs. There is a huge problem with adherence. We are moving forward because now we have the possibility of measuring the antihypertensive drugs in urine and in blood.
And there are the matters like prescription registries, we are actually using direct observed treatments and followed by ambulatory blood pressure measurements. So there are things you can do for the diagnosis.
What are the challenges?
The main challenge is that we simply don’t know how many people have refractory or resistant hypertension because of the uncertainties over whether they take their drugs or not.
So the challenges are really, point one to have people to take their drugs, and then to have the doctors and physicians to up-titrate the patients to reach their blood pressure targets, and make sure and convince the patients that they should take their drugs.
Then you probably remain with just one or two percent of the hypertensive patients remaining uncontrolled.
How do you deal with non-adherent patients?
That is an extremely complicated question. This has been on for 30, 40 years. It was very detailed in the Joint National Committee 4 in the US. You really need to convince people it is necessary to take the drugs. You need to go through it in detail, tell them about the side effects, tell them about the importance of taking it, tell them about the complications if they are not treated and taking the drugs. You need to control the blood, urine for taking the drugs, and so on. There’s a huge number of measurements you can do.
What is the future of research in resistant hypertension?
First we need to find out how many people really have resistant hypertension. There are new devices, renal denervation, we don’t know if this is lowering blood pressure or not, that’s not been decided yet. We have baroreceptor activating therapy, which is somewhat more promising but still needs more documentation from clinical trials. And we need to find out about the psychology of this, we need to find out the haemodynamics of resistant hypertension, we can adjust the drug treatment for the high total peripheral resistance and give them more diuretic treatments and can control the high blood pressure. And we can up-titrate people to the treatment targets.
So there’s a host of different things that need to be investigated further.