Manesh R. Patel, MD

Patient Case No. 1

Patient No. 1 has uncontrolled hypertension despite the use of 4 antihypertensive drugs. They have a slightly abnormal estimated glomerular filtration rate suggestive of early kidney involvement. Their creatinine level is elevated, indicating impaired renal function.

How would you approach the cause of uncontrolled blood pressure in this patient?

Videos

Difficult-to-treat hypertension is a condition where blood pressure remains uncontrolled despite the use of three or more antihypertensive medications, including a diuretic. This condition is distinct from resistant hypertension, which is more common and involves blood pressure that is not controlled with three medications but may not include a diuretic. Difficult-to-treat hypertension is less frequent, affecting a smaller subset of patients with high blood pressure. It often requires a more comprehensive approach, including lifestyle modifications and potential secondary causes evaluation, to achieve optimal management.

Panelists discuss how evaluating uncontrolled hypertension in patients with early kidney dysfunction requires a careful investigation of underlying causes, including medication adherence, lifestyle factors, and potential secondary hypertension.

Tips for Precise Readings

Panelists discuss how proper blood pressure measurement techniques require careful attention to patient positioning, cuff size selection, and standardized procedures to ensure accurate readings.

Hypertension in Pregnancy and Women

Video content above is prompted by the following:

How does aprocitentan address the current challenges associated with hypertension treatment (eg, improved efficacy: systolic/diastolic control 24 hours a day, improved safety regarding hyperkalemia/hypotension, and reduced drug-drug interactions)?

A panelist discusses how hypertensive disorders during pregnancy remain a leading cause of maternal mortality worldwide, affecting 5-10% of pregnancies and requiring careful monitoring, early detection, and appropriate medical management to protect both mother and baby.

PRECISION trial

The PRECISION trial was a phase 3, multicenter, randomized study of aprocitentan, a dual ERA, in patients with a systolic blood pressure of 140 mm Hg or higher despite taking 3 antihypertensive drugs, including a diuretic.

Panelists discuss how the PRECISION trial evaluated aprocitentan, a dual endothelin receptor antagonist (ERA), in patients with resistant hypertension taking 3 antihypertensive medications including a diuretic.

Manesh R. Patel, MD

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