Resistant hypertension (RH) is a prevalent medical problem across all ages but is more frequent in elderly
patients. This entity has to be distinguished from clinical settings which may simulate it such as apparent hypertension
(pseudohypertension) or apparently resistant hypertension (pseudoresistant hypertension) . An appropriate therapy for
RH can be achieved by the addition of second line antihypertensive drugs: antialdosteronic diuretics, central agents, alpha
blockers, direct vasodilating agents, and exogenous nitric oxide donors. These antihypertensive drugs are considered as
second line drugs since they are less effective as monotherapy to reduce blood pressure (they induce counte regulatory
responses that limit their antihypertensive effect such as volume expansion or reflex tachycardia) and prevent
cardiovascular events, or due to significant adverse effects (postural hypotension, sedation, hyperkalemia). Second line
drugs are also used when there is allergy or intolerance to the first line ones [2, 3].
Keywords: Hypertension, elderly, aldosterone, vasodilators, nitric oxide.
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