Refractory Hypertension

A REASONABLE definition of refractory hypertension might comprise these features: the blood pressure remains above 140/90 mm Hg (160/90 mm Hg for patients over 60 years of age), the routine evaluation does not suggest secondary hypertension, treatment with maximal doses of at least two appropriate antihypertensive agents has been initiated, and the antihypertensive regimen has been given adequate time to be effective. Though patients have traditionally been classified as having refractory hypertension only when they have not responded to treatment with three or four drugs, with the advent of newer and better-tolerated antihypertensive agents, many of which are highly effective . . .