PRECISION MEDICINE IN RESISTANT HYPERTENSION – A REVIEW

Resistant hypertension (RH) is characterized by blood pressure that remains elevated despite the use of three or more antihypertensives at maximum tolerated doses. This review explores the prevalence, pathophysiology, diagnosis, and treatment of RH, with a focus on precision medicine approaches. Pathophysiological mechanisms contributing to RH include primary aldosteronism, renal vascular hypertension, and obstructive sleep apnea. Diagnosis of RH requires careful exclusion of pseudoresistance. Treatment strategies for RH involve the use of first-line antihypertensives, followed by the addition of mineralocorticoid receptor antagonists and other approved drug classes. Precision medicine approaches, including
pharmacogenomics, gene therapy, and the use of biomarkers and diagnostic tools, help tailor medications to the right RH patient. Newer treatments, such as endothelin antagonists and aldosterone synthase inhibitors, are being investigated. Device-based therapies such as, renal denervation and baroreflex activation therapy, may be considered for patients with persistent RH despite optimal medical therapy. Lifestyle modifications, such as the DASH diet and
regular exercise, are essential components of RH management. The application of artificial intelligence and digital health technologies may further enhance the diagnosis and treatment of RH. Future directions include the development of novel pharmacologic agents, non-invasive neuromodulation techniques, and joint efforts by public and private institutions to validate biomarkers and optimize treatment strategies.

Keywords: Resistant hypertension, Pharmacogenomics, Applanation tonometry, Ultrasound based denervation, Precision medicine, DASH diet.