73
5.5.3. Short- and Long-Term Follow-Up of Pregnancy-
Associated Hypertension
5.6. Resistant Hypertension and Renal Denervation
COR LOE
Recommendations
Resistant Hypertension
1 B-NR
1. In adults with resistant hypertension, a more detailed
evaluation for secondary causes, to include careful review of all
medications and removal of those with interfering effects on
BP, is beneficial for lowering BP and simplifying treatment.
1 B-R
2. In adults with uncontrolled resistant hypertension despite
optimal treatment with first-line antihypertensive therapy
(ie, a combination of ACEi or ARB plus CCB and thiazide-
like diuretic [chlorthalidone or indapamide] and with an
eGFR of ≥45 ml/min/1.73 m
2
), addition of a MRA is
recommended to control BP.
2a B-NR
3. In adults with uncontrolled resistant hypertension who
cannot tolerate or have contraindications for MRA, the
addition of one of the following agent or classes — amiloride,
BBs, alpha blockers, central sympatholytic drugs, dual
endothelin receptor antagonists or direct vasodilators —
is reasonable to control BP.
Renal Denervation
2b B-R
4. In carefully selected patients with systolic and diastolic
hypertension (office SBP 140 to 180 mm Hg and DBP ≥90
mm Hg ) and eGFR ≥40 mL/min/1.73 m
2
who have resistant
hypertension despite optimal treatment, or intolerable side
effects to additional antihypertensive drug therapy, renal
denervation (RDN) may be reasonable as an adjunct treatment
to BP medications and lifestyle modification to reduce BP.
1 B-NR
5. All patients with hypertension who are being considered for
RDN should be evaluated by a multidisciplinary team with
expertise in resistant hypertension and RDN.
1 C-EO
6. For patients with hypertension for whom RDN is
contemplated, the benefits of lowering BP and potential
procedural risks compared with continuing medical therapy
should be discussed as part of a shared decision-making
process to ensure patients choose the therapy that meets their
expectations.
