Resistant
hypertension is defined as high blood pressure. It remains above goal in spite
of the concurrent use of three anti hypertensive agents of
different classes.These anti hypertensive agents are angiotensin-converting
enzyme inhibitor, a calcium channel blocker and a diuretic. All these agents
are prescribed at optimal dose amounts. It is a significant cause of morbidity
and mortality worldwide. Some symptoms of resistant hypertension are severe headaches,
anxiety, shortness of breath and nosebleeds.
There
are some causes of resistant hypertension such as primary causes and secondary
causes. Primary causes are related with both patient and physician. High sodium
intake, lack of life style adherence and poor adherence are some causes of
patient related whereas progressive renal insufficiency, sub clinical volume
over load and inadequate use of diuretics are causes of physician related.
Renal artery stenosis, thyroid diseases, intracranial tumours and Cushing’s
syndrome are some secondary causes of resistant hypertension.
According
to study, “Resistant Hypertension Global
Clinical Trials Review, H1, 2018” some of the major companies that are working in the
resistant hypertension are ViforPharma AG, Novartis AG, Johnson & Johnson, IMMD
Inc, Gilead Sciences Inc, Pfizer Inc, Metabolic Research Institute Inc, Idorsia
Pharmaceutical Ltd, C. H. BoehringerSohn AG & Co KG, Accelovance Inc.
The major factors contributing to hypertension are lifestyle factors, drug related
causes and volume overload. Some lifestyle factors are obesity, excess alcohol
intake, excess dietary sodium and cocaine & amphetamines misuse. Drug
related factors are herbal supplements, liquorice, sympathomimetic agents and
contraceptive harmones. Additionally, volume overload factors are high salt
intake, inadequate diuretic therapy and progressive renal insufficiency. There
are some risk factors are included in resistant hypertension such as diabetes,
older age, high baseline blood pressure, black race, chronic kidney disease and
obesity etc.
The
evolution of resistant hypertension is directed toward many terms, which are confirming
true treatment resistance, identification of causes contributing to treatment
resistance or including secondary causes of hypertension and documentation of
target-organ damage etc.
Some
treatments available for resistant hypertension are non-pharmacologic
intervention, drug intervention and device therapy. Non-pharmacologic
intervention do not involve medications: it included weight loss, regular
exercise, moderation of alcohol & caffeine and a high fiber or low fat or
low salt diet. A drug intervention is a process that helps a drug addict
recognize the extent of their problem. Some drugs spironolactone, clonidine,
nebivolol, labetalol, carvedilol CR, eplerenone, guanfacine, reserpine,
methyldopa, doxazosin, terazosin, hydralazine, minoxidil and ISMN. Device
therapy is defined by two techniques, which are renal sympathetic denervation
and carotid baroreflex activation. Renal sympathetic denervation significantly
reduces blood pressure in patients with resistant hypertension: it is
characterized by increased sympathetic activity such as left ventricular
hypertrophy, heart failure, metabolic syndrome, obstructive sleep apnea and
atrial fibrillation.
There
are many tests are used in investigation of resistant hypertension such as
renal echocardiogram, thyroid stimulating hormone, urine analysis (protein,
erythrocytes, leukocytes), transthoracic echocardiogram, 12-lead
electrocardiogram, complete blood count, ambulatory blood pressure monitoring,
renal artery duplex, plasma rennin or aldosterone levels, plasma glucose and 24-hour
urine assessment (aldosterone, sodium and albumin).
It
is estimated that patients with resistant hypertension are almost 50% more
likely to experience an adverse cardiovascular event compare with three or
fewer antipertensive agents. Resistant hypertension in adolescents is
increasing in frequency. Clinical trial data from Simplicity radio frequency catheter systems have created much interest in the role of the renal nerves in
hypertension and other cardiovascular conditions.
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below:-
Related
Report:-
https://www.kenresearch.com/healthcare/medical-devices/resistant-hypertension-pipeline/78636-91.html
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