Uncontrolled arterial hypertension in the mirror of ethiopathogenetic, diagnostic and clinical aspects of the disease

The term uncontrolled hypertension (UH) is commonly applied to all patients with hypertension (HTA) who do not achieve their target blood pressure (BP) for various reasons, which may include pseudoresistance or resistant HTA. Resistant HTA is defined as a BP reading exceeding 140/90 mmHg in the doctor’s office in patients who are on three or more antihypertensive medications, including diuretics, at optimal or maximally tolerated doses. Pseudoresistant HTA encompasses improper BP measurement techniques, white-coat effect, drug-induced HTA, secondary HTA, and incorrectness in antihypertensive management, whether due to suboptimal medication or nonadherence to treatment by patients. To define true resistant HTA, it is necessary to confirA adherence to treatment and eliminate potential secondary causes of HTA; otherwise, resistant HTN is merely apparent and termed as pseudoresistant HTA. For patients experiencing resistant HTA, the fourth-line treatment generally involves the use of a mineralocorticoid receptor antagonist (MRA), primarily spironolactone, followed by a beta blocker as the fifth option. The term refractory HTA refers to an ‘extreme phenotype’ of HTA, which is defined by the inability to control BP even when utilizing a regimen of five or more antihypertensive agents, including two of them being a long-acting thiazide-like diuretic and MRA. Acutely elevated BP also represent uncontrolled HTA, with guidelines recognizing at least two forms: moderately severe and extremely severe HTA crisis. The treatment approaches for these two categories differ significantly. We proposed a third category that addresses intermediate risk, which seems to be a logical extension of existing classifications.