Studies published in 2015 provide insight into the management of treatment-resistant hypertension, according to researchers.

Writing in Nature Reviews, Lilach O. Lerman, MD, and Stephen C. Textor, MD, of Mayo Clinic in Rochester, Minn., highlighted 2015 studies on resistant hypertension’s risks and vulnerability to newer therapeutic modalities.

First, a large cohort study found that uncontrolled resistant hypertension is associated with a 25% greater risk of end-stage renal disease and a 23% increased risk of cerebrovascular accidents compared with controlled resistant hypertension. Blood pressure (BP) control reduced these risks.

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Second, renal denervation, used extensively in Europe, has shown promise in several U.S. studies. In 2015, the Global Simplicity Registry reported that the treatment, which decreases activity of the renal artery’s sympathetic nerve, provides relatively safe BP reduction beyond intensive use of medication.

Third, spironolactone effectively lowers BP when used as fourth-line therapy, according to a phase 4 trial. The study showed it reduced home systolic BP by 8.7 mm Hg over placebo, 4.03 mm Hg over doxazosin, and 4.48 mm Hg over bisoprolol. Spironolactone has diuretic action, leading researchers to believe that sodium retention is a major mechanism underlying resistant hypertension.

Finally, studies confirmed that poor medication adherence remains a significant barrier to controlling hypertension and preventing kidney damage. A 2015 study found that optimizing diuretic therapy with sequential nephron blockade was the most effective strategy for controlling blood pressure and decreasing organ damage.


  1. Lerman LO and Textor SC. Resistant Hypertension: Impact and Evolving Treatment Options. Nature Reviews. doi: 10.1038/nrneph.2015.199.