This webinar was sponsored by Viatris in the interest of education, awareness, and support. The content and opinions expressed were entirely the speakers’ own work and not influenced by Viatris in any way. This webinar is accredited for one (1) CPD point. Certificates of attendance are available for attendees from other countries on request.
Diagnosing resistant hypertension
Defining resistant hypertension is pivotal in understanding the scope of the problem. The criterion for identifying resistant hypertension is inadequate blood pressure (BP) control despite being on multiple antihypertensive medications.
It is extremely important to exclude factors such as non-adherence or white coat effect before confirming true resistance, stressed Prof Rayner.
Factors contributing to resistance include age, obesity, salt intake, chronic kidney disease, diabetes, and race, with individuals of African descent being particularly susceptible.
Non-adherence and medication-related issues are identified as significant contributors to apparent resistance, underscoring the necessity for thorough diagnostic evaluation.
He highlighted the disparity in hypertension control between high-income countries and regions like Sub-Saharan Africa. While there has been notable improvement in control rates in the former, the latter continues to face challenges with rising prevalence rates.
Furthermore, he stressed that importance of timeous diagnosis and initiation of effective treatment, urging healthcare professionals at all levels to prioritise hypertension management.
Diagnostic approaches include accurate BP measurement using automated devices. Ambulatory BP monitoring is recommended to differentiate true resistance from white coat effect. Lifestyle modifications, including dietary changes and exercise are essential components of hypertension management.
Secondary causes of hypertension are addressed, with a call to consider and investigate conditions such as renal artery stenosis or primary aldosteronism.
Combination therapy as initial treatment
According to Prof Rayner, combination therapy should be used as first-line initial treatment. Specifically, a combination of an angiotensin receptor blocker or angiotensin-converting enzyme inhibitor with a calcium channel blocker (CCB) is often prescribed. Prof Rayner pointed out a deviation in treatment approach for patients of African descent, who may commence therapy with a CCB and a diuretic combination.
In cases of resistant hypertension, the addition of low-dose spironolactone is recommended, with careful monitoring for hyperkalaemia. Other treatment options include doxazosin, beta-blockers, and loop diuretics, chosen based on patient characteristics and response to previous therapies.
Prof Rayner stressed the importance of optimising medication dosing and addressing secondary causes of hypertension to achieve optimal blood pressure control.
Conclusion
The multifaceted nature of hypertension management requires a holistic approach that includes lifestyle modifications, adherence promotion, and appropriate medication selection.
To watch a replay of the video, go to: https://vimeo.com/event/4217407 or scan the QR code. If you watched the replay video, please send an email to john.woodford@newmedia.co.za to claim your CPD point. Include the name of the webinar in the subject line and your HPCSA number in the text. You can also email John for a certificate of attendance. Please confirm the validity of the certificate of attendance with your regulatory body.
