Resistant hypertension in elderly patient with nephropathy in primary and secondary care settings

Resistant hypertension is defined as a blood pressure above therapeutic goals, despite the concurrent use of three or more antihypertensive drugs of different pharmacological classes, and all being administered according to an optimum dosage schedule. The prevalence of resistant hypertension in the older people has not yet been exactly quantified. The updated available estimates deriving from some clinical trials report a prevalence of approximately 20-30% of all hypertensive patients. Advanced age seems to be an important risk factor in resistant forms of high blood pressure. Therefore this clinical condition may potentially increase in the coming years. Chronic kidney disease is the most frequent comorbidity associated with resistant hypertension and often leads to poor prognosis. The article describes a case report of an older subject with such a clinical condition suggesting diagnostic and therapeutic plan based on a rational strategy to control hypertension and the most recent knowledge reported in the medical literature.