Resistant Hypertension in Chronic Kidney Disease

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hypertension. Thus, data sharing around hypertensive patients should be achievable
in the four western provinces soon.
The self-management of hypertension is significant of its treatment. The patient
can manage their conditions. For instance, blood pressure monitoring at home has
been gradually underscored over the years, with available 2006 recommendations
bringing forward that all patients with hypertension monitor themselves [ 11 ] and
the results of the recent studies support that own blood pressure monitoring is useful
prognostic predictor and  succeed better in blood pressure control  [ 12 , 13 ]. In the
similar way, adherence to lifestyle advice can also mostly enhance blood pressure
levels and decline other cardiovascular risk factors (Table 15.2). The primary care
physician is important for both introducing and continually reassuring patient self-
management. In the same way, primary care groups or the health system itself can
ease self-management by courtesy of the arrangement of educational and motiva-
tional programs, patient portals, and engagement of other community resources.

Pseudo-Resistant Hypertension due to Poor Medication

Adherence

In the beginning, a large number of the patients were considered to have resistant
hypertension; in clinical trials in which the participants were aggressively titrated to
reach a target BP, the prevalence of RHT was estimated to be 20–30% [ 14 ]. Although
a large amount of the studies determine RHT based on the medical adherence and
optimal levels of drug prescriptions and blood pressure first, it should be confirmed
that the patients with resistant hypertension do have true RHT; this can be done by
ruling out or correcting factors associated with pseudo-resistance which include an
inaccurate measurement of BP, inappropriate drug choices or doses, and the nonad-
herence to prescribed therapy or the white-coat effect [ 15 , 16 ]. The prevalence of
RHT has been re-estimated to be below 15% as a significant group of patients with
RHT were actually considered to have “pseudo-resistant” hypertension [ 17 ].
A major methodological strength is the exclusion of patients with pseudo-
resistance due to nonadherence with prescribed antihypertensive medications; this
determination has been lacking in prior epidemiologic assessments of RHT [ 17 ]. It
was observed that 152 (43.9%) of 359 patients did not adhere to antihypertensive

Table 15.2 Lifestyle
changes as adjunctive therapy
for antihypertensive
medication

Weight reduction

Increasing physical activity

Moderation of alcohol consumption

Adoption of the Dietary Approaches

to Stop Hypertension (DASH) diet

Dietary salt reduction

Smoking cessation

15 Public Health Efforts for Earlier Resistant Hypertension Diagnosis...