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This article discusses the potential benefits of inhibiting the renin-angiotensin system (RAS) in preventing hypertension. Hypertension is a global health problem that increases the risk of cardiovascular diseases. The RAS plays a crucial role in the development of hypertension, and pharmacological inhibition of the RAS can lower blood pressure. However, long-term treatment with RAS inhibitors can lead to side effects and poor compliance. The article explores the epigenetic mechanisms behind the long-term effects of RAS inhibition and identifies potential gene targets for future treatments. While animal studies have shown promising results, clinical trials have not yet confirmed the same effects in humans. Further research is needed to fully understand and utilize the potential of RAS inhibition in preventing hypertension. [Extracted from the article]

Resistant hypertension (RH) is defined as systolic blood pressure (SBP) or diastolic blood pressure (DBP) that remains .140 mmHg or .90 mmHg, respectively, despite an appropriate lifestyle and the use of optimal or maximally tolerated doses of a three-drug combination, including a diuretic. This definition encompasses the category of controlled RH, defined as the presence of blood pressure (BP) effectively controlled by four or more antihypertensive agents, as well as refractory hypertension, referred to as uncontrolled BP despite five or more drugs of different classes, including a diuretic. To confirm RH presence, various causes of pseudo-resistant hypertension (such as improper BP measurement techniques and poor medication adherence) and secondary hypertension must be ruled out. Inadequate BP control should be confirmed by out-of-office BP measurement. RH affects about 5% of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Once RH presence is confirmed, patient evaluation includes identification of contributing factors such as lifestyle issues or interfering drugs/substances and assessment of hypertension-mediated organ damage. Management of RH comprises lifestyle interventions and optimisation of current medication therapy. Additional drugs should be introduced sequentially if BP remains uncontrolled and renal denervation can be considered as an additional treatment option. However, achieving optimal BP control remains challenging in this setting. This review aims to provide an overview of RH, including its epidemiology, pathophysiology, diagnostic work-up, as well as the latest therapeutic developments., Competing Interests: Disclosure: MLM is a section editor on the European Cardiology Review editorial board; this did not influence peer review. All other authors have no conflicts of interest to declare., (Copyright © The Author(s), 2024. Published by Radcliffe Group Ltd.)