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April 13, 2026Current Hypertension Reviews

Resistant hypertension affects up to 10% of hypertensive patients globally; integrating optimized pharmacotherapy and emerging options like aldosterone synthase inhibition, dual endothelin receptor antagonism, small-interfering RNA strategies, and device-based approaches offers incremental BP reductions.

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Population

Patients with resistant hypertension.

Design

Review

Authors

MMManjappa MahadevappaHNHarini NarayanBSBharath Raj Srinivasan

Discussion

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Overview

A multidimensional approach integrating adherence assessment, secondary cause evaluation, pharmacologic intensification, and selective device therapy is critical for achieving durable blood pressure control in resistant hypertension.

Key Points

  • The aim is to review the pathophysiology, diagnostic criteria, and emerging therapeutic strategies for resistant hypertension.
  • Conducted a narrative review using PubMed and Scopus databases.
  • Focused on literature from January 2000 to June 2025.
  • Prioritized guidelines, randomized controlled trials, and systematic reviews relevant to resistant hypertension.
  • Resistant hypertension affects up to 10% of global hypertensive patients.
  • Prevalence is higher in those with chronic kidney disease and obstructive sleep apnea.
  • Misdiagnosis and poor medication adherence are significant challenges.
  • Promising treatments include mineralocorticoid receptor antagonists, renal denervation, and baroreceptor therapies.

Structured PICO

P
Population
Patients with resistant hypertension (defined as blood pressure remaining uncontrolled despite concurrent use of three antihypertensive agents from different classes, including a diuretic).
I
Intervention
Diagnostic approaches and therapeutic strategies including lifestyle modifications, mineralocorticoid receptor antagonists, aldosterone synthase inhibitors, renal denervation, baroreceptor therapies, zilebesiran, and aprocitentan.

A multidimensional approach integrating adherence assessment, secondary cause evaluation, pharmacologic intensification, and selective device therapy is critical for achieving durable blood pressure control in resistant hypertension.

Limitations

  • lack of large-scale comparative trials
  • accessibility concerns in low-resource settings

Cite This Study

Mahadevappa et al. (2026) studied this question.

synapsesocial.com/papers/69dc88b93afacbeac03ea713https://doi.org/10.2174/0115734021429097260401053734
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