The recommended treatment and testing for uncontrolled hypertension involves a combination of pharmacological interventions, lifestyle modifications, and regular monitoring of blood pressure and treatment response.
Pharmacological interventions
- For patients with resistant hypertension, the ESC 2024 guidelines suggest adding spironolactone to existing treatment. If spironolactone is not effective or tolerated, alternatives such as eplerenone, a β-blocker, a centrally acting blood pressure-lowering medication, an α-blocker, hydralazine, or a potassium-sparing diuretic may be considered
Lifestyle modifications
- Lifestyle modifications are recommended for all patients with hypertension, including those with comorbid conditions such as chronic kidney disease (CKD) and diabetes mellitus
- These modifications include adopting a heart-healthy diet, such as the DASH diet, increasing physical activity, reducing sodium intake, increasing potassium intake (unless contraindicated), moderating alcohol intake, and achieving a desirable weight
- Stress management and smoking cessation are also recommended as part of the lifestyle modifications
Monitoring and follow-up
- Regular monitoring of blood pressure and assessment of treatment response are crucial. The AAPA/ABC/ACC/ACPM/AGS/AHA/APhA/ASH/ASPC/NMA/PCNA 2018 guidelines recommend follow-up evaluations at monthly intervals until control is achieved
- Self-measured blood pressure monitoring at home is a validated approach for out-of-office blood pressure measurement and is associated with a reduction in blood pressure and improved blood pressure control
- Systematic strategies to help improve blood pressure, including home blood pressure monitoring, team-based care, and telehealth strategies, are recommended in the follow-up and monitoring after initiating pharmacotherapy for hypertension control
The management of uncontrolled hypertension involves a combination of pharmacological interventions, lifestyle modifications, and regular monitoring of blood pressure and treatment response. These strategies aim to reduce cardiovascular disease risk and improve blood pressure control.