Clinical approach to resistant hypertension through individualized therapeutic adjustment: a case study
DOI:
https://doi.org/10.71068/hs000103Keywords:
resistant hypertension, ambulatory monitoring, adherence, spironolactone, individualized treatment.Abstract
Introduction: This case addresses hipertensión arterial resistente verdadera, a clinically relevant condition in which early recognition, structured assessment, and risk-adapted treatment can substantially modify outcomes. The presentation illustrates how nonspecific or complex findings may delay diagnosis when they are interpreted separately. Objective: To describe the diagnostic reasoning, individualized intervention, multidisciplinary decisions, and clinical evolution of an adult patient with hipertensión arterial resistente verdadera. Case presentation: A 59-year-old patient presented with cefalea matutina recurrente y cifras domiciliarias persistentes entre 165-180/95-105 mmHg pese a cuatro fármacos. Clinical assessment, laboratory testing, targeted imaging, differential diagnosis, treatment, and follow-up were documented sequentially. Results: The integrated evaluation established hipertensión resistente confirmada por monitorización ambulatoria, con contribución de exceso de sodio, adherencia subóptima y probable hiperaldosteronismo primario. Management included simplificación a combinaciones de dosis fija, sustitución del diurético por tiazídico de acción prolongada, adición de antagonista mineralocorticoide, reducción de sodio y optimización de CPAP. The patient showed descenso progresivo de presión arterial domiciliaria hasta 128-136/76-84 mmHg, mejor adherencia, potasio estable y reducción del promedio ambulatorio a los tres meses. Conclusions: The case highlights the value of linking diagnostic probability, objective severity, repeated reassessment, and individualized treatment. A favorable outcome depended on timely decisions, coordinated care, and a structured follow-up plan rather than on a single diagnostic test or isolated intervention. Clear escalation criteria and patient education supported safe transitions between acute care and outpatient follow-up.
References
1. Schiffrin EL, Fisher NDL. Diagnosis and management of resistant hypertension. BMJ. 2024;385:e079108. https://doi.org/10.1136/bmj-2023-079108.
2. Cluett JL, William JH. Evaluation and management of resistant hypertension: Core Curriculum 2024. Am J Kidney Dis. 2024;84(3):374-387. https://doi.org/10.1053/j.ajkd.2024.04.009.
3. Parodi R, Brandani L, Romero C, Klein M. Resistant hypertension: diagnosis, evaluation, and treatment practical approach. Eur J Intern Med. 2024;123:1-8. https://doi.org/10.1016/j.ejim.2023.12.026.
4. Lauder L, Mahfoud F, Böhm M. Management of resistant hypertension. Annu Rev Med. 2024;75:443-457. https://doi.org/10.1146/annurev-med-050922-052605.
5. Lamirault G, Artifoni M, Daniel M, Barber-Chamoux N. Resistant hypertension: novel insights. Curr Hypertens Rev. 2020;16(1):61-72. https://doi.org/10.2174/1573402115666191011111402.
6. Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al. The management of resistant hypertension: a 2020 update. Prog Cardiovasc Dis. 2020;63(5):662-670. https://doi.org/10.1016/j.pcad.2020.08.001.
7. Nardoianni G, Pala B, Scoccia A, Volpe M, Barbato E, Tocci G. New drug strategies for treating resistant hypertension: the importance of a mechanistic, personalized approach. High Blood Press Cardiovasc Prev. 2024;31(2):99-112. https://doi.org/10.1007/s40292-024-00634-4.
8. Biffi A, Dell’Oro R, Quarti-Trevano F, Cuspidi C, Corrao G, Mancia G, et al. Effects of renal denervation on sympathetic nerve traffic and correlates in drug-resistant and uncontrolled hypertension. Hypertension. 2023;80(3):659-667. https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
9. Chen C, Zhu XY, Li D, Lin Q, Zhou K. Clinical efficacy and safety of spironolactone in patients with resistant hypertension: a systematic review and meta-analysis. Medicine (Baltimore). 2020;99(34):e21694. https://doi.org/10.1097/MD.0000000000021694https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
10. Blumenthal JA, Hinderliter AL, Smith PJ, Mabe S, Watkins LL, Craighead L, et al. Effects of lifestyle modification on patients with resistant hypertension: results of the TRIUMPH randomized clinical trial. Circulation. 2021;144(15):1212-1226. https://doi.org/10.1161/CIRCULATIONAHA.121.055329https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
11. Yamamoto E, Sueta D, Tsujita K. Renal denervation in resistant hypertension: a review of clinical trials and future perspectives. Cardiovasc Interv Ther. 2022;37(3):450-457. https://doi.org/10.1007/s12928-022-00854-2https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
12. Kario K, Yokoi Y, Okamura K, Fujihara M, Ogoyama Y, Yamamoto E, et al. Catheter-based ultrasound renal denervation in patients with resistant hypertension: the randomized, controlled REQUIRE trial. Hypertens Res. 2022;45(2):221-231. https://doi.org/10.1038/s41440-021-00754-7https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
13. Azizi M, Mahfoud F, Weber MA, Sharp ASP, Schmieder RE, Lurz P, et al. Effects of renal denervation vs sham in resistant hypertension after medication escalation: prespecified analysis at 6 months of the RADIANCE-HTN TRIO randomized clinical trial. JAMA Cardiol. 2022;7(12):1244-1252. https://doi.org/10.1001/jamacardio.2022.3904https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
14. Barbato E, Azizi M, Schmieder RE, Lauder L, Böhm M, Brouwers S, et al. Renal denervation in the management of hypertension in adults: a clinical consensus statement of the ESC Council on Hypertension and EAPCI. Eur Heart J. 2023;44(15):1313-1330. https://doi.org/10.1093/eurheartj/ehad054https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
15. Silverwatch J, Marti KE, Phan MT, Amin H, Roman YM, Pasupuleti V, et al. Renal denervation for uncontrolled and resistant hypertension: systematic review and network meta-analysis of randomized trials. J Clin Med. 2021;10(4):782. https://doi.org/10.3390/jcm10040782https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
16. Ahmed M, Nudy M, Bussa R, Naccarelli GV, Filippone EJ, Foy AJ. A subgroup meta-analysis comparing the renal denervation sham-controlled randomized trials among those with resistant and nonresistant hypertension. Am J Cardiol. 2023;191:119-124. https://doi.org/10.1016/j.amjcard.2022.12.032https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
17. Zeijen VJM, Kroon AA, van den Born BH, Blankestijn PJ, Meijvis SCA, Nap A, et al. The position of renal denervation in treatment of hypertension: an expert consensus statement. Neth Heart J. 2023;31(1):3-11. https://doi.org/10.1007/s12471-022-01717-4https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
18. Liang B, Liang Y, Li R, Gu N. Effect of renal denervation on long-term outcomes in patients with resistant hypertension. Cardiovasc Diabetol. 2021;20(1):117. https://doi.org/10.1186/s12933-021-01309-3https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
19. Messerli FH, Bavishi C, Brguljan J, Burnier M, Dobner S, Elijovich F, et al. Renal denervation in the antihypertensive arsenal-knowns and known unknowns. J Hypertens. 2022;40(10):1859-1875. https://doi.org/10.1097/HJH.0000000000003171https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
20. Azzam O, Heidari Nejad S, Carnagarin R, Nolde JM, Galindo-Kiuchi M, Schlaich MP. Taming resistant hypertension: the promise of novel pharmacologic approaches and renal denervation. Br J Pharmacol. 2024;181(3):319-339. https://doi.org/10.1111/bph.16247https://doi.org/10.1161/HYPERTENSIONAHA.122.20503.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Britany Tatiana Zavala Sánchez
This work is licensed under a Creative Commons Attribution 4.0 International License.
Articles published in this journal are available under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence. This licence authorises third parties to download, copy, distribute, adapt and reuse the contents, including for commercial purposes, provided that credit is given to the original author of the work.
