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    Preferred Fourth-Line Pharmacotherapy for Resistant Hypertension: Are We There Yet?

    Access Status
    Fulltext not available
    Authors
    Prosser, H.
    Gregory, C.
    Hering, D.
    Hillis, G.
    Perry, G.
    Rosman, Johan
    Schultz, C.
    Thomas, M.
    Watts, G.
    Schlaich, M.
    Date
    2017
    Type
    Journal Article
    
    Metadata
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    Citation
    Prosser, H. and Gregory, C. and Hering, D. and Hillis, G. and Perry, G. and Rosman, J. and Schultz, C. et al. 2017. Preferred Fourth-Line Pharmacotherapy for Resistant Hypertension: Are We There Yet?. CURRENT HYPERTENSION REPORTS. 19 (4).
    Source Title
    CURRENT HYPERTENSION REPORTS
    DOI
    10.1007/s11906-017-0728-z
    ISSN
    1522-6417
    School
    Curtin Medical School
    URI
    http://hdl.handle.net/20.500.11937/73213
    Collection
    • Curtin Research Publications
    Abstract

    © 2017, Springer Science+Business Media New York. Resistant hypertension (RH) is defined as blood pressure (BP) that remains above target levels despite adherence to at least three different antihypertensive medications, typically including a diuretic. Epidemiological studies estimate that RH is increasing in prevalence, and is associated with detrimental health outcomes. The pathophysiology underlying RH is complex, involving multiple, overlapping contributors including activation of the renin-angiotensin aldosterone system and the sympathetic nervous system, volume overload, endothelial dysfunction, behavioural and lifestyle factors. Hypertension guidelines currently recommend specific pharmacotherapy for 1st, 2nd and 3rd-line treatment, however no specific fourth-line pharmacotherapy is provided for those with RH. Rather, five different antihypertensive drug classes are generally suggested as possible alternatives, including: mineralocorticoid receptor antagonists, a1-adrenergic antagonists, a2-adrenergic agonists, ß-blockers, and peripheral vasodilators. Each of these drug classes vary in their efficacy, tolerability and safety profile. This review summarises the available data on each of these drug classes as a potential fourth-line drug and reveals a lack of robust clinical evidence for preferred use of most of these classes in the setting of RH. Moreover, there is a lack of direct comparative trials that could assist in identifying a preferred fourth-line pharmacologic approach and in providing evidence for hypertensive guidelines for adequate treatment of RH.

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