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Table 6: Hypertension phenotypes according to responsiveness to treatment. |
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Phenotype |
Pseudo resistant |
Resistant |
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Definition |
When treatment control objectives are not achieved with a combination of three drugs at correct doses, including a thiazide-type diuretic, but adequate non-pharmacological measures have not been established or secondary causes have not been ruled out. |
When the BP control goals are not achieved despite having established the appropriate non-pharmacological measures and treatment with a combination of three drugs at correct doses, one of which must be a thiazide diuretic. |
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Etiology |
Poor adherence to treatment. Suboptimal doses and/or pharmacological combinations. Improper lifestyle Unidentified secondary cause White or masked coat effect Concomitant use of drugs that stimulate the increase in BP such as NSAIDs, vasoconstrictors, etc. |
Multifactorial |
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Pathophysiology |
Unknown |
Unknown |
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Prognosis |
Increased cardiovascular and renal risk. |
Increased cardiovascular and renal risk. |
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Treatment |
Education and eliminating the cause of pseudo resistance. |
Evaluate therapies with the addition of a 4th drug such as spironolactone and rule out a secondary cause. Use alternatives such as renal denervation and carotid stimulation devices in specialized centers. |
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BP = Blood pressure, NSAID = Non-steroidal anti-inflamatory drugs |
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