الفهرس 
HypertensionOnly 14 pages are availabe for public view
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Abstract
Resistant hypertension: an approach to management in primary care
Hypertension is a challenging clinical problem with a significant
proportion of patients failing to achieve blood pressure control despite
extensive medical therapy. Resistant hypertension is defined as blood
pressure that remains above 140/90 mmHg despite optimal use of three
antihypertensive medications of different classes, including a diuretic.
Such patients are more likely to have a secondary cause and to suffer endorgan
damage.
Most individuals with resistant hypertension will achieve norm
tension with conscientious treatment decisions. Patients must be
approached in a stepwise manner beginning with traditional
antihypertensive therapy followed gradually by additional agents to reach
a quadruple or five-drug compound regimen if necessary. In those who
remain hypertensive despite thorough medical management, there are
interventional options currently under development which are promising
but require further research.
Life style changes such as increase in physical activity, reduction of
body weight and sodium intake, moderate coffee consumption and
supplementation in olive oil can be very helpful in preventing
hypertension, reducing blood pressure values and decreasing
cardiovascular risk. However, poor compliance is very frequent and still
represents the main obstacle to this kind of effective and moneysaving
therapeutic approach.
A recent study in which compliance of women to many lifestyle
changes was evaluated underlined that a good compliance (80%) was
obtained only in the case of substitution of sugar with edulcorates, while
all the other changes (reduction of total fats, of NaCl, increase in fibers,etc.) were associated with compliance levels usually below 10%. The
problem of compliance is quite complex and needs a Strict cooperation
between doctors and patients. The first who must become aware of this
are physicians, who frequently find it much easier to prescribe a pill than
to instruct the patient about how to successfully change their Lifestyle.
There is sufficient data to suggest that certain lifestyle
modifications, such as weight loss and Naþ intake reduction, are
efficacious in lowering BP, reducing progression of prehypertension to
hypertension, and perhaps diminishing long-term risk of CV events.
However, the effectiveness of such lifestyle modifications needs to be
further established in population-based studies, as implementation of
healthier lifestyles is challenging.