Resistant Hypertension — Course Text

The module that starts by refusing the question

Our first Resistant Hypertension module presents a patient on three agents whose pressure remains high and asks learners to plan the workup. Most produce a reasonable secondary-cause investigation. The module then reveals that the patient collects repeat prescriptions at four-month intervals for a monthly medication.

It is a cheap trick and it works. Learners do not forget to check adherence again.

Sequence of the modules

Pseudo-resistance first — measurement technique, white-coat effect, dosing adequacy and adherence. Only then the secondary causes: primary aldosteronism at the weight the evidence supports rather than the footnote it usually receives, renal artery disease, sleep apnoea, phaeochromocytoma, and drug-induced hypertension including the agents patients do not think of as drugs.

Management beyond three agents closes the block, including spironolactone as fourth-line and the current position of renal denervation.

Who enrols

General physicians and family doctors, who manage most resistant hypertension in practice; nephrologists; diabetologists; and cardiology trainees. The modules assume no specialist background.

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