© Springer International Publishing AG 2017 89
A. Covic et al. (eds.), Resistant Hypertension in Chronic Kidney Disease,
DOI 10.1007/978-3-319-56827-0_7
Chapter 7
Pathophysiological Insights in Resistant
Hypertension
Alexandru Burlacu and Adrian Covic
Introduction
Background: Exploring Paradigms and Controversies
Resistant hypertension (RH) is an entity still incompletely explained and studied
from the perspective of the physiopathological mechanisms, no more than it is its
“mother” condition, essential hypertension.
Therefore, our endeavor in the pathophysiologic characterization of RH must
start with an “essential” question: is RH really a distinct entity or is it just:
(a) The same disease as essential hypertension, with the same pathways, but in an
advanced stage?
Corollary 1. Is there a borderline from which a “regular” essential hypertension
becomes true resistant (e.g., contexts like obesity, sleep apnea, diabetes mellitus, in
which hypertension can be managed at first but later becomes permanent and
irreversible)?
(b) The same disease which implies/recruits more neurohumoral and molecular
mechanisms than “regular” hypertension?
Corollary 2. Are there specific mechanisms involved from the very beginning
(genetic mutations – Na+ absorption, bone marrow and neuroinflammation, hypo-
reninemic hypertension in Afro-Americans), or are we talking about the progressive
A. Burlacu (*)
Department of Interventional Cardiology,
Cardiovascular Diseases Institute – Iaşi, Iaşi, Romania
e-mail: [email protected]
A. Covic
Professor Internal Medicine & Nephrology, Grigore T. Popa University of Medicine,
Iaşi, Romania