TY - JOUR
T1 - Resistant Hypertension and the Pivotal Role for Mineralocorticoid Receptor Antagonists
T2 - A Clinical Update 2016
AU - Epstein, Murray
AU - Duprez, Daniel A.
N1 - Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - True resistant hypertension must be distinguished from apparent resistant hypertension, of which important causes include medication nonadherence, illicit drug use, and alcoholism. Ambulatory blood pressure monitoring should be considered to rule out white coat hypertension. The pathogenesis is multifactorial, but the 2 pivotal factors include volume excess and the myriad effects of aldosterone. Aldosterone increases vascular tone because of endothelial dysfunction and enhances the pressor response to catecholamines. It also plays a crucial role in vascular remodeling of small and large arteries. Aldosterone also promotes collagen synthesis, which leads to increased arterial stiffness and elevation of blood pressure. Because aldosterone has been demonstrated to modulate baroreflex resetting, in cases of severe hypertension, there would be fewer compensatory mechanisms available to offset the blood pressure elevation.
AB - True resistant hypertension must be distinguished from apparent resistant hypertension, of which important causes include medication nonadherence, illicit drug use, and alcoholism. Ambulatory blood pressure monitoring should be considered to rule out white coat hypertension. The pathogenesis is multifactorial, but the 2 pivotal factors include volume excess and the myriad effects of aldosterone. Aldosterone increases vascular tone because of endothelial dysfunction and enhances the pressor response to catecholamines. It also plays a crucial role in vascular remodeling of small and large arteries. Aldosterone also promotes collagen synthesis, which leads to increased arterial stiffness and elevation of blood pressure. Because aldosterone has been demonstrated to modulate baroreflex resetting, in cases of severe hypertension, there would be fewer compensatory mechanisms available to offset the blood pressure elevation.
KW - Aldosterone
KW - Carotid baroreceptor stimulation
KW - Mineralocorticoid receptor antagonists
KW - Renal nerve denervation
KW - Resistant hypertension
KW - Spironolactone
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U2 - 10.1016/j.amjmed.2016.01.039
DO - 10.1016/j.amjmed.2016.01.039
M3 - Review article
C2 - 26899747
AN - SCOPUS:84962276527
SN - 0002-9343
VL - 129
SP - 661
EP - 666
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 7
ER -