Current approach to resistant hypertension

Resistant hypertension is the inability to achieve target blood pressure (<130/80 mmHg) despite using the maximum tolerated doses of three antihypertensive drugs, including a diuretic, or the need for four or more medications. It is linked to aging, obesity, obstructive sleep apnea, and chronic kidney disease, with contributing factors such as high sodium intake and sympathetic nervous system overactivity. Treatment includes optimizing diuretic use, with spironolactone proving highly effective. Lifestyle modifications, including sodium reduction and exercise, are critical. Emerging therapies like renal denervation offer promising long-term blood pressure control.