Journal of Diagnostics Concepts & Practice >
Prevalence， diagnosis， and treatment progress of resistant hypertension
Received date: 2025-09-02
Revised date: 2025-10-03
Accepted date: 2025-10-07
Online published: 2025-10-25
Resistant hypertension (RH), defined as uncontrolled blood pressure despite the use of optimal combination therapy, represents a major clinical treatment challenge. Its underlying mechanism is a complex pathophysiological network involving multiple interacting systems, primarily including excessive activation of the renin-angiotensin-aldosterone system (RAAS), increased excitability of the sympathetic nervous system (SNS), genetic predisposition, vascular endothelial dysfunction, and inflammatory responses. These are closely associated with significantly increased cardiovascular risk. RH accounts for 1.9%-18.0% of the hypertensive population, with most studies indicating about 10% of hypertensive patients have RH. Evaluation of RH requires standardized blood pressure measurement (with a combination of office and home blood pressure recommended), and objective evaluation of patient medication adherence (with poor adherence observed in nearly 50% of patients). Screening for secondary causes of hypertension is crucial. For example, the prevalence of primary aldosteronism among RH patients reaches 17%-23% (with a screening rate of only 2.1%). Over 50% of patients with sleep apnea syndrome have hypertension, and renal artery stenosis hypertension accounts for about 24% of RH patients. Comprehensive identification of the underlying causes of hypertension can significantly improve blood pressure control and prognosis. RH treatment emphasizes lifestyle interventions [such as DASH (dietary approaches to stop hypertension) diet, which can reduce blood pressure by about 6.97 mmHg], as well as drug and device-based therapies. Spironolactone, as the preferred fourth-line agent, can reduce systolic blood pressure by about 8.70 mmHg. Among novel agents, the aldosterone synthase inhibitors lorundrostat and baxdrostat reduced systolic blood pressure by approximately 9.1 mmHg and 9.8 mmHg compared with placebo, respectively, while aprocitentan lowered systolic blood pressure by about 3.7 mmHg compared with placebo. Renal sympathetic denervation (RDN) can persistently reduce ambulatory systolic blood pressure by about 13.6 mmHg, with good safety. Looking ahead, driven by both evidence-based medicine and innovative therapies (new drugs and devices), RH treatment is undergoing a paradigm shift centered on precision and individualized care, which is expected to bring revolutionary impact on the improvement of patient prognosis.
Key words： Hypertension; Resistant hypertension; Diagnosis; Treatment
MA Zhiqiang , LIN Zixin , WU Hao , WANG Zaijia , ZHANG Xiangtao , DONG Yifei . Prevalence， diagnosis， and treatment progress of resistant hypertension[J]. Journal of Diagnostics Concepts & Practice, 2025 , 24(05) : 471 -484 . DOI: 10.16150/j.1671-2870.2025.05.002
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