Hypertension is one of the most common condition seen in general clinical practice. Hypertension if not treated can lead to many serious complications such as stroke, myocardial infarction, renal failure and eventually death. The incidence of resistant hypertension defined as the inability to achieve target blood pressure despite optimal doses of 3 or more antihypertensive drugs, including one diuretic is increasing. Resistant hypertension further increases the risk of cardiovascular complications. The diagnosis of resistant hypertension is mainly by exclusion criteria. White coat syndrome and poor adherence to treatment should be excluded. Management involves multiple approaches such as lifestyle interventions and pharmacological treatment. Initial pharmacological treatment begins with optimization of diuretic use. Other first line drugs are calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers. Combination of other drugs is used as per individual patient need. Spironolactone has shown promising results in the management. Various device therapies like chronic electrical stimulation of the carotid sinus and Catheter-based renal sympathetic denervation have been tried in the management of resistant hypertension though the success is still eluding. The endothelin receptor antagonists and minodoxil are being evaluated in the management of resistant hypertension.
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