[Persistent arterial hypertension].

Abstract

Antihypertensive therapy has markedly improved, in the last few years, but, in some patients, the blood pressure remains high despite an association of several medications. We are proposing to consider as persistent or refractory, any essential hypertension remaining higher than or equal to 165/95 despite a well administered triple therapy, initiated since at least one month. With such patients, the first step consists in verifying the various terms of the definition: measurement of the blood pressure under standard condition and, at best, over a long period of time, in ambulatory conditions; re-evaluation of the drug combination (synergistic action); observance of the treatment by the patient; re-investigation of the etiology; determination of the resistance factors to the treatment. The treatment should then be patiently and methodically reviewed, based on the most potentialized combinations, taking into consideration the first signs of occurrence of the hypertension, without neglecting hygieno-dietetic measures. Sometimes, it will be necessary to resort to more potent treatments, which are more delicate to handle.