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Management of resistant hypertension: expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology

Journal of Human Hypertension volume 30, pages 657–663 (2016)Cite this article

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Abstract

To improve the management of resistant hypertension, the French Society of Hypertension, an affiliate of the French Society of Cardiology, has published a set of eleven recommendations. The primary objective is to provide the most up-to-date information based on the strongest scientific rationale and that is easily applicable to daily clinical practice. Resistant hypertension is defined as uncontrolled blood pressure on office measurements and confirmed by out-of-office measurements despite a therapeutic strategy comprising appropriate lifestyle and dietary measures and the concurrent use of three antihypertensive agents including a thiazide diuretic, a renin-angiotensin system blocker (ARB or ACEI) and a calcium channel blocker, for at least 4 weeks, at optimal doses. Treatment compliance must be closely monitored, as must factors that are likely to affect treatment resistance (excessive dietary salt intake, alcohol, depression, drug interactions and vasopressor drugs). If the diagnosis of resistant hypertension is confirmed, the patient should be referred to a hypertension specialist to screen for potential target organ damage and secondary causes of hypertension. The recommended treatment regimen is a combination therapy comprising four treatment classes, including spironolactone (12.5–25 mg per day). In the event of a contraindication or a non-response to spironolactone, or if adverse effects occur, a β-blocker, an α-blocker, or a centrally acting antihypertensive drug should be prescribed. Because renal denervation is still undergoing assessment for the treatment of hypertension, this technique should only be prescribed by a specialist hypertension clinic.

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Authors and Affiliations

  1. Société française d’hypertension artérielle, Paris, France

    T Denolle, B Chamontin, G Doll, J-P Fauvel, X Girerd, D Herpin, B Vaïsse, F Villeneuve & J M Halimi

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  1. T Denolle
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  2. B Chamontin
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  4. J-P Fauvel
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  5. X Girerd
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  7. B Vaïsse
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  8. F Villeneuve
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Correspondence to T Denolle.

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Competing interests

The authors of these guidelines have several links of interest with manufacturers who sell health products. The authors declare that these recommendations have been developed independently of any commercial entity.

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Denolle, T., Chamontin, B., Doll, G. et al. Management of resistant hypertension: expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology. J Hum Hypertens 30, 657–663 (2016). https://doi.org/10.1038/jhh.2015.122

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