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Resistant hypertension in times of changing definitions and treatment recommendations
  1. Milad Nazarzadeh1,2,
  2. Ana-Catarina Pinho-Gomes1,
  3. Kazem Rahimi1
  1. 1 George Institute for Global Health, University of Oxford, Oxford, UK
  2. 2 Collaboration Center of Meta-Analysis Research, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
  1. Correspondence to Professor Kazem Rahimi, George Institute for Global Health, University of Oxford, Oxford OX1 2JD, UK; kazem.rahimi{at}georgeinstitute.ox.ac.uk

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Hypertension is one of the most prevalent conditions in the world. Despite evidence of the beneficial effects of blood pressure (BP)-lowering across a range of patient groups,1 treatment and control rates remain suboptimal in high-income and low-income countries alike.2 To alert physicians to the fact that some patients with hypertension might benefit from specialist assessment for possible underlying causes or more advanced treatment recommendations, clinical practice guidelines introduced a new subcategory of hypertension called resistant hypertension (figure 1). The European Society of Cardiology (ESC) guidelines defined resistant hypertension as the failure to achieve BP ‘control’ to levels below 140/90 mm Hg despite treatment with three antihypertensive medications with complementary mechanisms of action (with at least one diuretic).3 The American Heart Association (AHA) guidelines adopted an extended definition to also include patients with four or more antihypertensive medications, even when BP was controlled.4 To acknowledge the fact that an ‘apparent’ resistant hypertension might turn out to be spurious (because of measurement error, white coat effect or poor patient adherence to …

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