Patient Case No. 1

Author(s):

Manesh R. Patel, MD,Payal Kohli, MD, FACC

Key Takeaways

Difficult-to-treat hypertension involves uncontrolled blood pressure despite using three or more antihypertensive medications, including a diuretic.
It is distinct from resistant hypertension, which is more common and may not include a diuretic in treatment.
This condition affects a smaller subset of patients with high blood pressure and requires a comprehensive management approach.
Lifestyle modifications and evaluation for secondary causes are crucial for optimal management of difficult-to-treat hypertension.

Panelists discuss how evaluating uncontrolled hypertension in patients with early kidney dysfunction requires a careful investigation of underlying causes, including medication adherence, lifestyle factors, and potential secondary hypertension.

EP: 1.Unmet Needs in HTN: Patient Adherence, Comorbid Conditions, and Prevalence

EP: 2.Current Limitations With Traditional Antihypertensive Drugs

EP: 3.Drug Classes Available to Treat Patients With High Blood Pressure

EP: 4.Difficult-to-Treat Hypertension Treatment Strategies

EP: 5.Current Therapeutic Guidelines for Managing Resistant Hypertension

EP: 6.Endothelin Pathway

EP: 7.PRECISION trial

EP: 8.Hypertension in Pregnancy and Women

EP: 9.Tips for Precise Readings

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EP: 10.Patient Case No. 1

Patient No. 1 has uncontrolled hypertension despite the use of 4 antihypertensive drugs. They have a slightly abnormal estimated glomerular filtration rate suggestive of early kidney involvement. Their creatinine level is elevated, indicating impaired renal function.
How would you approach the cause of uncontrolled blood pressure in this patient?