Improved Understanding and Innovative Approaches for an Aging Dilemma: Resistant Hypertension in Women with Existing Vascular Disease

Approximately half of adults with hypertension in the United States are uncontrolled and perhaps, based on most recent data, 12 %–15 % are considered resistant. Moreover, compared with men, women have more prevalent resistant hypertension with greater older age status and obesity, 2 of the strongest predictors. Resistant hypertension is more common in African Americans and more frequent with concomitant heart disease, heart failure, diabetes, stroke, and chronic kidney disease. In addition to lifestyle modifications, effective treatment mandates combination therapy, including appropriate diuretics, renin-angiotensin system blockers, calcium channel blockers, and underutilized aldosterone antagonists. Emerging, innovative interventions, including renal artery denervation and carotid stimulation treatment, are potentially effective and well-tolerated approaches to blood pressure control.