By Massimo Salvetti (auth.)

This ebook is designed to aid physicians within the daily administration of hypertensive sufferers, with a specific concentrate on difficult-to-treat and resistant high blood pressure. the chosen medical instances are consultant of the sufferers who're obvious within the “real world”, instead of infrequent medical circumstances, and supply examples of administration in line with present foreign guidance. The eventualities thought of comprise not just situations during which arterial high blood pressure is really resistant but in addition situations of pseudo-resistant high blood pressure, together with instances during which resistance is expounded to comorbidities, concomitant remedies, or using medicinal drugs. the last word goal is to supply paradigmatic examples of evidence-based techniques to difficult-to-treat sufferers that would support physicians to choose the main acceptable diagnostic instruments and evidence-based therapy process for every person patient.

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22 Clinical Case 2. 1 mV). The repolarization was normal. Fundoscopic Examination An ophthalmological evaluation for the assessment of hypertensive retinal changes was urgently performed. The exam was substantially normal. Current Treatment Amlodipine 10 mg once daily (h 8:00). Diagnosis The patient was seen at the echolab with the provisional diagnosis of: – Severe (grade 3) new onset hypertension (suspect secondary hypertension, workup in progress). – Primary hypothyroidism due to Hashimoto’s thyroiditis.

16 Clinical Case 1. Adult Patient with True Resistant… Take-Home Messages (continued) • The combination of drugs, in most cases, should include a full-dose diuretic, an ACE inhibitor or an angiotensin receptor blocker and a calcium antagonist, in the absence of compelling indications for different drugs. e. spironolactone, even at low doses (25–50 mg/day) and with the alpha-1-blocker doxazosin. • Very recent data give further support to the use of antialdosterone drugs as fourth drug in these patients.

2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281–357. 3. Farese Jr RV, Biglieri EG, Shackleton CH, et al. Licorice induced hypermineralocorticoidism. N Engl J Med. 1991;325(17):1223–7. 4. Walker BR, Edwards CR. Licorice-induced hypertension and syndromes of apparent mineralocorticoid excess. Endocrinol Metab Clin North Am.

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