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Prkacin I, Balenovic D, Djermanovic-Dobrota V, et al. Resistant hypertension and chronotherapy. Mater Sociomed. 2015;27(2):118-21doi: 10.5455/msm.2015.27.118-121.
Prkacin, I., Balenovic, D., Djermanovic-Dobrota, V., Lukac, I., Drazic, P., & Pranjic, I. K. (2015). Resistant hypertension and chronotherapy. Materia socio-medica, 27(2), 118-21. https://doi.org/10.5455/msm.2015.27.118-121
Prkacin, Ingrid, et al. "Resistant hypertension and chronotherapy." Materia socio-medica vol. 27,2 (2015): 118-21. doi: https://doi.org/10.5455/msm.2015.27.118-121
Prkacin I, Balenovic D, Djermanovic-Dobrota V, Lukac I, Drazic P, Pranjic IK. Resistant hypertension and chronotherapy. Mater Sociomed. 2015 Apr;27(2):118-21. doi: 10.5455/msm.2015.27.118-121. Epub 2015 Apr 05. PMID: 26005390; PMCID: PMC4404987.
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Mater Sociomed. 2015 Apr;27(2):118-21. doi: 10.5455/msm.2015.27.118-121. Epub 2015 Apr 05.

Resistant hypertension and chronotherapy.

Materia socio-medica

Ingrid Prkacin, Diana Balenovic, Vesna Djermanovic-Dobrota, Iva Lukac, Petra Drazic, Iva-Klara Pranjic

Affiliations

  1. Merkur University Hospital, Department of Internal Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia.
  2. General Hospital Sisak, Department of Internal Medicine, Sisak, Croatia.
  3. General Hospital Zadar, Department of Emergency Medicine, Zadar, Croatia.

PMID: 26005390 PMCID: PMC4404987 DOI: 10.5455/msm.2015.27.118-121

Abstract

Resistant hypertension is defined as blood pressure that remains above 140/90 mmHg in spite of the continuous use of three antihypertensive agents in optimal dose, including diuretic, and lifestyle changes. According to data from United States of America and Europe, the prevalence ranges from 10 up to 30% in patients with hypertension. Numerous biological and lifestyle factors can contribute to the development of resistant hypertension: medications, volume overload, obesity, diabetes mellitus, older age, renal parenchymal and renovascular disease, primary aldosteronism, obstructive sleep apnea, pheochormocytoma, Cushing's syndrome, thyroid diseases, aortic coarctation. For diagnosing patient's history is important, assessing compliance, regular blood pressure measurement, physical examination, biochemical evaluation and noninvasive imaging. The evaluation including 24h ambulatory monitoring of blood pressure (ABPM) in the identification of "non-dipper" hypertension. Non-dipper has particular importance and the prevalence of abnormally high sleep blood pressure is very often in chronic kidney patients. Therapeutic restoration of normal physiologic blood pressure reduction during night-time sleep (circadial variation) is the most significant independent predictor of decreased risk and the basis for the chronotherapy. The resistant hypertension treatment is achieved with nonpharmacological and pharmacological approach, treating secondary hypertension causes and invasive procedures.

Keywords: chronotherapy; circadian variation; resistant hypertension

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