190 - Can’t Stop, Won’t Drop … The BP That Just Won’t Quit: Diagnosis and Treatment of Resistant Hypertension

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 29 May 2025

⏱️ 53 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we discuss the diagnosis and treatment of resistant hypertension, including a newer endothelin receptor antagonist (ERA) called aprocitentan (Tryvio®).

Key Concepts

The diagnosis of true resistant hypertension is based on requiring more than 3 antihypertensives (ACE inhibitor or ARB + calcium channel blocker + diuretic) to achieve goal BP, ruling out inaccurate BP readings, and ensuring patient adherence to their antihypertensive therapy.
Non-pharmacologic therapy (especially dietary sodium restriction), medication adherence, and lifestyle changes are critical to the treatment of resistant hypertension.
The preferred 4th line option for most patients with resistant hypertension is spironolactone.
After adding spironolactone, additional therapies are based on expert opinion and patient-specific factors. These additional therapies may include beta blockers, alpha-2 agonists, alpha-1 blockers, hydralazine, minoxidil, and aprocitentan.

References

Carey RM, Calhoun DA, Bakris GL, et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018;72(5):e53-e90. doi:10.1161/HYP.0000000000000084
Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071. doi:10.1097/HJH.0000000000003480

Transcript

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0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not professional
0:22.4	advice and should not be used in lieu of obtaining advice from a qualified health care provider.
0:27.2	And now on to the show.
0:31.1	Welcome to Helix Talk episode 190. I'm your co-host Dr. Kane. And I'm Dr. Patel. And the title of
0:37.0	today's episode is Can't Stop, Won't Kane. And I'm Dr. Patel. And the title of today's episode is,
0:38.1	Can't Stop, Won't Drop, That BP That Just Won't Quit,
0:42.2	Diagnosis and Treatment of Resistant Hypertension.
0:45.5	Dr. Kane, I'm really excited because I get to see this in primary care all the time
0:49.9	where patients are on multiple medications,
0:53.8	and for whatever reason, their blood pressure is still not
0:56.4	control. So this is right up my alley as well. Love it. And even in the ICU, we see lots of
1:01.3	patients with very resistant hypertension, but more commonly it's for a variety of other reasons.
1:06.3	So we're really just focused today on kind of that ambulatory care patient with chronic drug-resistant hypertension.
1:12.2	And what a great way to kind of transition to like a typical patient that we might see in
1:15.5	clinic. Right. And I believe there is a new drug in the category of endotheline receptor agonist
1:21.0	out called a prosa-tentan, trivio. So we kind of go over that a little bit too. For sure. So imagine that you have a 60-year-old woman coming to clinic with hypertension follow-up.
1:32.1	She has a history of diabetes, chronic kidney disease with an EGFR of about 30, hypertension, and preserve D.F heart failure.
1:40.2	Two weeks ago, she was seen in clinic. She had her amylotapine dose increased, and she's been monitoring her blood pressure at home. And she says she hasn't missed any doses, so she's been adherent to her blood pressure medications. She sometimes feels a little bit fatigued or dizzy, but really she's doing pretty well in terms of not having a lot of side effects to her current blood pressure medications.
2:02.1	And those blood pressure medication, as you said, you know, amylopine 10 milligrams daily.
2:06.4	That dose was recently increased. She was on 5 milligrams before that. So just two weeks ago was
	...

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