ABC | Volume 114, Nº3, March 2020

Statement Brazilian Position Statement on Resistant Hypertension – 2020 Arq Bras Cardiol. 2020; 114(3):576-596 Content 1. Definition and Epidemiology .........................................................580 1.1. Definition/New Concepts ..................................................................580 1.2. Control of Hypertension in Brazil and Worldwide ...............................580 1.3. Incidence and Prevalence of Resistant Hypertension ........................580 1.4. Factors Related to Resistant Hypertension .......................................580 2. Prognostic Aspects ..........................................................................581 2.1. Introduction ......................................................................................581 2.2. Office Blood Pressure and Ambulatory Blood Pressure Monitoring ...581 2.3. Target-Organ Damage .......................................................................581 2.3.1. Central Arterial Pressure and Arterial Stiffening ..........................581 2.3.2. Left Ventricular Hypertrophy ........................................................581 2.3.3. Albuminuria ..................................................................................581 2.3.4. Inflammatory Biomarkers .............................................................581 3. Flowchart of Assessment of Resistant Hypertension .............581 3.1. Flowchart of the Diagnostic Approach in Resistant Hypertension ......581 4. Blood Pressure Measurement .......................................................582 4.1. Office Blood Pressure in Resistant Hypertension ............................582 4.2. Ambulatory Blood Pressure Monitoring in Resistant Hypertension ....582 4.3. Home Blood Pressure Monitoring and Blood Pressure Self- Measurement ..........................................................................................583 4.4. Measurement of Central Arterial Pressure ........................................583 5. Target-Organ Damage ....................................................................583 5.1. Introduction ......................................................................................583 5.2. Vascular Changes .............................................................................583 5.3. Cerebral Changes .............................................................................583 5.4. Cardiac Changes ...............................................................................583 5.5. Renal Changes ..................................................................................584 6. Phenotype of the Patient with Resistant Hypertension ............584 6.1. Introduction ......................................................................................584 6.2. Phenotype of the Patient with Resistant Hypertension ......................584 6.3. Phenotype of Controlled and Uncontrolled Resistant Hypertension ...585 6.3.1. Pathophysiological Aspects ...........................................................585 6.3.2. Clinical Differences ......................................................................585 6.3.3. Prognosis ......................................................................................585 6.4. Phenotype of the Patient with Refractory Hypertension ....................586 7. Secondary Causes of Resistant Hypertension ............................586 7.1. Introduction ......................................................................................586 7.2. Secondary Hypertension due to Non-Endocrine Causes .....................586 7.2.1. Obstructive Sleep Apnea ..............................................................586 7.2.2. Renal Parenchymal Disease ..........................................................586 7.2.3. Renal Artery Stenosis ....................................................................586 7.3. Secondary Hypertension due to Endocrine Causes ............................586 7.3.1. Primary Hyperaldosteronism ........................................................586 7.3.2. Pheochromocytoma ......................................................................587 7.3.3. Hypothyroidism and Hyperthyroidism .........................................587 8. Non-Pharmacological Treatment ..................................................587 8.1. Weight Loss ......................................................................................587 8.2. Salt Restriction .................................................................................588 8.3. Alcohol Intake ...................................................................................588 8.4. Physical Activity ................................................................................589 9. Pharmacological Treatment of Resistant Hypertension ........589 10. New Treatments of Resistant Hypertension ..........................589 10.1. Introduction ....................................................................................589 10.2. Direct Carotid Sinus Stimulation .....................................................589 10.3. Renal Sympathetic Denervation .....................................................590 10.4. Use of Continuous Positive Airway Pressure ....................................590 10.5. Arteriovenous Fistula ......................................................................591 References ............................................................................................591 579