Description
The patient on three drugs who is still hypertensive
Uncomplicated hypertension needs no book. What generates clinic time, referrals and eventual organ damage is the patient already on three agents at proper doses whose pressure remains above target — and the commonest reason is not resistance at all.
These 278 pages are about that patient specifically.
Pseudo-resistance first
The volume opens where practice should: measurement error, white-coat effect, inadequate dosing, and non-adherence — which studies repeatedly show accounts for a large share of apparent resistance and is almost never the first thing investigated. Establishing genuine resistance before working it up saves considerable expense and patient exposure.
Then the secondary causes
Primary aldosteronism, given the weight it deserves rather than the footnote it usually gets, since it is both commoner and more treatable than most clinicians assume. Renal artery disease. Obstructive sleep apnoea. Phaeochromocytoma. Drug-induced hypertension, including the agents patients do not consider medication.
Management beyond three drugs
Sequencing, the role of spironolactone as a fourth agent, and where renal denervation currently sits in the evidence.
Academy placement
Prevention track reading, and recommended to general physicians and nephrologists as well as cardiologists — most resistant hypertension is managed outside cardiology clinics.
PDF, lifetime access, from CardiologyBooks.com.
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