Blood Pressure Monitoring

measurements

accuracy

MeSH

Diagnosis and Management of Resistant Hypertension: A Review

RPR Commentary: Proper measurement technique is essential for accurate BP determination. James W. Mold, MD, MPH

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Do recommended blood pressure (BP) measurement techniques impact the accuracy of readings?

Cuff size, arm position, bladder distention, and leg crossing affect systolic BP (SBP) and diastolic BP (DBP) measurement accuracy (1 mm Hg lower to 20 mm Hg higher). Thin clothing does not impact readings. A 5-minute rest before measurement may give more accurate readings if SBP is 140 mm Hg or higher. Hypertension Canada recommendations are reasonable.

Author/s:

Tony Nickonchuk, Adrienne J. Lindblad, Danielle Perry, Scott Garrison

Diagnosis and Management of Resistant Hypertension: A Review

Megan George — Wed, 29 Apr 2026 21:23:10 +0000

Date Added:

April 29, 2026

Journal/Publication:

JAMA

Publication Date:

March 23, 2026

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.1221

Keywords

drug therapy

Drug Resistance

Antihypertensive Agents

Antihypertensive Agents* / therapeutic use

PMID (1):

41870448

MeSH

drug resistance, bacterial

Ambulatory

drug therapy

Combination

Hypertension* / complications

female

male

Humans

Hypertension* / drug therapy

Hypertension* / epidemiology

Hypertension* / therapy

Recommendations for the diagnosis and management of patients with resistant hypertension. James W. Mold, MD, MPH

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Importance: Hypertension, defined as office systolic blood pressure (SBP) 130 mm Hg or greater and/or diastolic blood pressure 80 mm Hg or greater, affects 43.9% of women and 49.5% of men in the US. Approximately 19.7% of patients treated for hypertension have apparent resistant hypertension (blood pressure ≥130/80 mm Hg) despite using 3 or more antihypertensive medications, preferably a renin-angiotensin system blocker, a calcium channel blocker, and a thiazide-type diuretic, at maximally tolerated doses.

Observations: Approximately 10% of patients treated for hypertension have true resistant hypertension confirmed with home or 24-hour ambulatory blood pressure monitoring to exclude white-coat hypertension (approximately 37.5% of apparent resistant hypertension) and after excluding medication nonadherence (approximately 50%) and secondary hypertension such as primary aldosteronism (approximately 5%-25%). Conditions associated with resistant hypertension include obesity, diabetes, chronic kidney disease, and sleep apnea. Resistant hypertension is associated with increased risk of cardiovascular death vs controlled blood pressure at 5 years to 10 years (absolute risk increase, 10.3% [95% CI, 8.7%-12.1%]). Lifestyle modifications for resistant hypertension include a low-sodium diet (<1500 mg/d), reducing or avoiding alcohol, 150 min/wk or more of aerobic exercise, and weight loss. Illicit drugs (eg, cocaine) and medications that increase blood pressure (eg, nonsteroid anti-inflammatory drugs, serotonin-norepinephrine reuptake inhibitors) should be avoided. Sleep apnea should be treated when diagnosis is confirmed. Pharmacologic optimization includes use of combination tablets of antihypertensives; intensifying diuretic therapy by using chlorthalidone; and sequential addition of antihypertensive medications using evidence-based algorithms. In a meta-analysis of 20 studies (9 randomized clinical trials [RCTs] and 11 observational studies [331 participants]), use of antihypertensive therapies that combine 2 to 3 medications into a single formulation reduced SBP by -3.99 mm Hg (95% CI, -7.92 to -0.07) vs equivalent doses given separately. For patients with apparent or true resistant hypertension who have an estimated glomerular filtration rate of 45 mL/min/1.73 m2 or greater and a serum potassium level of 4.5 mmol/L or less, adding spironolactone (25-50 mg/d) compared with placebo lowers office SBP by -13.3 mm Hg (95% CI, -17.89 to -8.72 [4 RCTs]) and 24-hour ambulatory SBP by -8.46 mm Hg (95% CI, -12.54 to -4.38 [2 RCTs]) in a network meta-analysis of 24 RCTs (3485 patients with resistant hypertension). A meta-analysis of 10 RCTs (2478 participants) reported that compared with a sham procedure, catheter-based renal denervation, which disrupts the sympathetic nerves in the renal artery walls, decreased 24-hour ambulatory SBP by -4.4 mm Hg (95% CI, -6.1 to -2.7) and office SBP by -6.6 mm Hg (95% CI, -9.7 to -3.6).

Conclusions and relevance: True resistant hypertension affects 10% of patients treated for hypertension and is diagnosed after excluding white-coat hypertension, medication nonadherence, and secondary hypertension such as primary aldosteronism. First-line treatment includes lifestyle modifications, diuretic therapy with chlorthalidone, and combination tablets of antihypertensives. Spironolactone and renal denervation decrease blood pressure in patients with true resistant hypertension.

Author/s:

Michel Azizi, Wanpen Vongpatanasin, Naomi D. L. Fisher

Diagnosis and Management of Resistant Hypertension: A Review

Megan George — Tue, 24 Mar 2026 16:14:03 +0000

Date Added:

March 24, 2026

Journal/Publication:

JAMA

Publication Date:

March 23, 2026

URL:

Diagnosis and Management of Resistant Hypertension: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2026.1221

Keywords

Antihypertensive Agents

Resistant Hypertension

Hyperaldosteronism

Anti-Inflammatory Agents

PMID (1):

41870448

MeSH

Ambulatory

antihypertensive agents

renin-angiotensin system

resistant hypertension

The Effect of Aged Garlic Extract on the Atherosclerotic Process - A Randomized Double-Blind Placebo-Controlled Trial

White Coat Hypertension

Hyperaldosteronism

Anti-Inflammatory Agents

A review of the evaluation and management of patients with resistant hypertension. James W. Mold, MD, MPH

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Author/s:

Michel Azizi, Wanpen Vongpatanasin, Naomi D L Fisher, Felix Mahfoud, Laurence Amar, Ajay J Kirtane

The Effect of Aged Garlic Extract on the Atherosclerotic Process - A Randomized Double-Blind Placebo-Controlled Trial

Brian Desmarais — Sat, 02 May 2020 19:53:28 +0000

Date Added:

May 2, 2020

Journal/Publication:

BMC Complimentary Medicine and Therapies

Publication Date:

May 29, 2020

Issue:

Volume:

Pages:

132

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1186/s12906-020-02932-5

Keywords

MeSH