Review

Resistant hypertension: A stepwise approach

Jordana Yahr, DO, George Thomas, MD, Juan Calle, MD and Jonathan J. Taliercio, DO
Cleveland Clinic Journal of Medicine February 2023, 90 (2) 115-125; DOI: https://doi.org/10.3949/ccjm.90a.22046

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Management of resistant hypertension, recommendations adapted from the American Heart Association scientific statement on resistant hypertension, reference 2.

    ABPM = ambulatory blood pressure monitoring; ACEi = angiotensin-converting enzyme inhibitor; ARB = angiotensin II receptor blocker; DASH = Dietary Approaches to Stop Hypertension; MRA = mineralocorticoid receptor antagonist; NSAIDs = nonsteroidal anti-inflammatory drugs; OCPs = oral contraceptive pills; SMBP = self-measured blood pressure

Tables

  • TABLE 1

    Proper blood pressure measurement

    Patients should sit, relaxed, for at least 5 minutes, with an empty bladder, without talking; they should not have consumed caffeine, smoked, or exercised in the last 30 minutes.
    Use a device that has been properly calibrated, and a proper-sized cuff: the bladder should wrap around 80% of the patient’s arm; a small cuff will result in higher blood pressure readings.
    Take measurements in both arms, on bare skin, with the patient’s arm supported; use the arm with the higher reading for subsequent readings, and repeat measurements 1 to 2 minutes apart.
    Use the average of at least 2 readings obtained on at least 2 occasions to estimate blood pressure.

    • Based on information in reference 1.

  • TABLE 2

    Patterns of in-office and out-of-office blood pressure in treated hypertension

    Out-of-office blood pressure
    (by daytime ambulatory or home blood pressure monitoring)
    NormalHigha
    In-office blood pressureHighaWhite-coat effectUncontrolled hypertension
    NormalControlled hypertensionMasked uncontrolled hypertension

    • ↵a Blood pressure 130/80 mm Hg or higher.

    • Adapted from information in reference 7.

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