Prof Thomas Kahan, Danderyd University Hospital, Stockholm, Sweden

Thomas Kahan, Professor of Medicine & Cardiologist, Danderyd University Hospital, Stockholm, Sweden, talks to Cardio Debate about resistant hypertension and treating patients with uncontrolled blood pressure.

What is pseudo-resistant hypertension?
Resistant hypertension is a term you use when blood pressure is not controlled. And pseudo-resistant hypertension, or rather apparent hypertension, is what you usually use to describe patients who have three or maybe four drugs, but still have their blood pressure uncontrolled.

The difference between true resistant hypertension and pseudo-resistant hypertension is that there are many unrecognized reasons for hypertension that you can actually treat if you do a proper workup.

Does it exist?
If you look into survey, perhaps half or even two-thirds of all patients treated for hypertension are uncontrolled. And they are then often called ‘pseudo-resistant’ but that is not true because there are few patients with true resistant hypertension – perhaps one our of 10. So it’s a big group in between.

But those with true resistant hypertension are a medical challenge because they are difficult to treat, they have a poor prognosis, they have very high risk of cardiovascular events.

Is renal denervation the answer to resistant hypertension?
If you have true resistant hypertension, we are at the dead end. We have used several drugs, we cannot control the blood pressure. Then there are several device therapies – renal denervation is one of them – that may be the solution. It’s promising, it should work. The physiology is there. But we are not really there in the clinical setting to know how to do it the best way and how to choose the proper patients. But I am quite sure that we will reach it within a few years.