Med. praxi. 2012;9(12):499-501

A case of resistant arterial hypertension in a 37-year-old man

MUDr.Pavel Lang¹, MUDr.Ondřej Petrák, Ph.D.², MUDr.Pavel Nedbal³

¹ Oddělení všeobecné interny, Krajská nemocnice Liberec, a. s.

² 3. interní klinika &ndash, klinika endokrinologie a metabolismu VFN a 1. LF UK Praha

³ Oddělení neinvazivní kardiologie, Kardiocentrum, Krajská nemocnice Liberec, a. s

Arterial hypertension affects an average of 30 % of patients over 60 years of age and is one of the major health concerns. Despite modern

pharmacotherapy and the use of combination therapy, some patients are unable to achieve optimal blood pressure control. Hypertension

is typically defined as resistant, or refractory, to treatment when the blood pressure value is 140/90 or higher despite complying with

a therapeutic plan, including both nonpharmacological measures, such as lifestyle and dietary measures, and pharmacotherapy containing

at least a triple combination of drugs in adequate doses, including a diuretic (1). The estimated prevalence of resistant hypertension based on

the data from large preventive and morbidity-mortality studies, such as ALLHATT (2), VALUE (3), ASCOTT (4), and CONVINCE (5), is reported

to be 7–15 %. Some clinical studies, such as Syst-Eur (Systolic Hypertension in Europe, 43 %) (6) or LIFE (7) (Losartan Intervention for Endpoint

Reduction in Hypertension, 26 %) even suggest that the numbers of cases with resistant arterial hypertension are increasing. Certainly,

these figures are overestimated by the selection of patients and exceed the prevalence of resistant hypertension in the general population.

However, referral of a patient to a specialist or a specialized center is strongly recommended since inadequate blood pressure control results

in end-organ damage and an increased risk of cardiovascular mortality usually associated with severe forms of arterial hypertension.

drug levels.

Keywords: arterial hypertension, pseudoresistance, adherence to/compliance with treatment, toxicological analysis of serum antihypertensive

Published: January 1, 2013  Show citation