[Therapy-resistant hypertension].

BACKGROUND: Therapy-resistant hypertension is commonly encountered in daily practice. It is present when the therapeutic goal is not achieved after trying at least three antihypertensives from different groups with adequate doses and including a diuretic. Between 10 and 20% of patients are affected and their prognosis is poor. Thus, intensive strategies are required to achieve normotension. DIAGNOSIS: An exact diagnosis is essential. Pseudoresistance needs to be excluded in addition to secondary hypertension and sleep apnea syndrome. The most common cause of pseudoresistance is incorrect blood pressure measurement, false estimation of the real blood pressure level, lack of compliance, unhealthy lifestyle, and drug interactions. Therapeutic resistance should not be diagnosed without 24 h ambulatory blood pressure measurement. This significantly reduces the total number of "resistant" patients. THERAPY: Successful control of blood pressure is achieved in the majority of patients by taking advantage of all possible therapy options. Treatment with 4-6 antihypertensive drugs is justified because of the improvement of cardiovascular prognosis. However, prerequisite is the absence of undesirable side effects which is the most important condition for adequate and reliable patient compliance. Only in the case of failure of the above therapy options can invasive procedures--renal denervation and baroreflex activation therapy--be applied as they are still experimental. Successful management of patients with resistant hypertension is only possible with intensive and time-consuming physician-patient relationships.