Resistant and Refractory Hypertension: A Guideline Topline for Primary Care

Treatment-resistant hypertension is defined by inadequate response to multiple medications, but is correctly diagnosed and treated with more intensive regimens after other considerations, including whether the initial treatment regimen was optimized and the blood pressures were accurately determined. Hypertension that appears refractory to treatment requires further assessment of the treatment regimen, and ascertaining underlying pathophysiology to guide successful treatment modification. Both types are associated with increased comorbidity and increased cardiovascular risk.

This Patient Care Guideline Topline on resistant and refractory hypertension is drawn from a 2023 review, in a series on controversies in hypertension published this year in The American Journal of Medicine.¹ The last clinical practice guideline on hypertension in the US was issued by the American Academy of Family Physicians (AAFP)² in 2022, and was highlighted in a Guideline Topline here in 2023.

References
1. Filippone EJ, Naccarelli GV, Foy AJ. Controversies in hypertension V: Resistant and refractory hypertension. Am J Med. 2024; 137:12-22. doi: 10.1016/j.amjmed.2023.09.015
2. Coles S, Fisher L, Lin KW, et al. Blood pressure targets in adults with hypertension: A clinical practice guideline from the AAFP. Am Fam Physician. 2022 Dec;106(6):online