{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T21:28:36Z","timestamp":1789766916573,"version":"4.0.1"},"reference-count":30,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Stroke Vasc Neurol"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:p>Resistant hypertension (failure to achieve target blood pressures with three or more antihypertensive drugs including a diuretic) is an important and preventable cause of stroke. Hypertension is highly prevalent in China (&gt;60% of persons above age 65), and only ~6% of hypertensives in China are controlled to target levels. Most strokes occur among persons with resistant hypertension; approximately half of strokes could be prevented by blood pressure control. Reasons for uncontrolled hypertension include (1) non-compliance; (2) consumption of substances that aggravated hypertension, such as excess salt, alcohol, licorice, decongestants and oral contraceptives; (3) therapeutic inertia (failure to intensify therapy when target blood pressures are not achieved); and (4) diagnostic inertia (failure to investigate the cause of resistant hypertension). In China, an additional factor is lack of availability of appropriate antihypertensive therapy in many healthcare settings. Sodium restriction in combination with a diet similar to the Cretan Mediterranean or the DASH (Dietary Approaches to Stop Hypertension) diet can lower blood pressure in proportion to the severity of hypertension. Physiologically individualised therapy for hypertension based on phenotyping by plasma renin activity and aldosterone can markedly improve blood pressure control. Renal hypertension (high renin\/high aldosterone) is best treated with angiotensin receptor antagonists; primary aldosteronism (low renin\/high aldosterone) is best treated with aldosterone antagonists (spironolactone or eplerenone); and hypertension due to overactivity of the renal epithelial sodium channel (low renin\/low aldosterone; Liddle phenotype) is best treated with amiloride. The latter is far more common than most physicians suppose.<\/jats:p>","DOI":"10.1136\/svn-2017-000138","type":"journal-article","created":{"date-parts":[[2018,2,25]],"date-time":"2018-02-25T01:10:36Z","timestamp":1519521036000},"page":"69-75","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":31,"title":["Controlling resistant hypertension"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7478-1098","authenticated-orcid":false,"given":"J David","family":"Spence","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,2,24]]},"reference":[{"key":"2020050723410030000_3.2.69.1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.106.475525"},{"key":"2020050723410030000_3.2.69.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j3984"},{"key":"2020050723410030000_3.2.69.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000158925.12740.87"},{"key":"2020050723410030000_3.2.69.4","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1161\/01.STR.17.5.808","article-title":"Antihypertensive drugs and prevention of atherosclerotic stroke","volume":"17","author":"Spence","year":"1986","journal-title":"Stroke"},{"key":"2020050723410030000_3.2.69.5"},{"key":"2020050723410030000_3.2.69.6","doi-asserted-by":"crossref","first-page":"2559","DOI":"10.1016\/S0140-6736(17)32476-5","article-title":"Availability, cost, and prescription patterns of antihypertensive medications in primary health care in China: a nationwide cross-sectional survey","volume":"390","author":"Su","year":"2017","journal-title":"Lancet"},{"key":"2020050723410030000_3.2.69.7","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002497"},{"key":"2020050723410030000_3.2.69.8","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.2.6.757"},{"key":"2020050723410030000_3.2.69.9","first-page":"649","article-title":"Antihypertensive persistence and drug class","volume":"18","author":"Marentette","year":"2002","journal-title":"Can J Cardiol"},{"key":"2020050723410030000_3.2.69.10","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.113.059121"},{"key":"2020050723410030000_3.2.69.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.10.011"},{"key":"2020050723410030000_3.2.69.12","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1038\/jhh.2017.45","article-title":"The association between consistent licorice ingestion, hypertension and hypokalaemia: a systematic review and meta-analysis","volume":"31","author":"Penninkilampi","year":"2017","journal-title":"J Hum Hypertens"},{"key":"2020050723410030000_3.2.69.13","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s00210-016-1272-0","article-title":"Combined oral contraceptive-induced hypertension is accompanied by endothelial dysfunction and upregulated intrarenal angiotensin II type 1 receptor gene expression","volume":"389","author":"Olatunji","year":"2016","journal-title":"Naunyn Schmiedebergs Arch Pharmacol"},{"key":"2020050723410030000_3.2.69.14","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1210\/jc.2016-3851","article-title":"Effect of Combined Hormonal Replacement Therapy on the Aldosterone\/Renin Ratio in Postmenopausal Women","volume":"102","author":"Ahmed","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"2020050723410030000_3.2.69.15","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1016\/S0140-6736(86)91271-7","article-title":"Effect of non-steroidal anti-inflammatory drugs on control of hypertension by beta-blockers and diuretics","volume":"1","author":"Wong","year":"1986","journal-title":"Lancet"},{"key":"2020050723410030000_3.2.69.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198402023100502"},{"key":"2020050723410030000_3.2.69.17","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.1987.44"},{"key":"2020050723410030000_3.2.69.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jash.2008.03.010"},{"key":"2020050723410030000_3.2.69.19","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1212\/WNL.0000000000003952","article-title":"Alcohol use and risk of intracerebral hemorrhage","volume":"88","author":"Chen","year":"2017","journal-title":"Neurology"},{"key":"2020050723410030000_3.2.69.20","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.cjca.2015.02.031","article-title":"Dilemmas in diagnosing and managing hypertension: is white coat hypertension benign?","volume":"31","author":"Spence","year":"2015","journal-title":"Can J Cardiol"},{"key":"2020050723410030000_3.2.69.21","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199811123392002"},{"key":"2020050723410030000_3.2.69.22","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1161\/HYPERTENSIONAHA.115.06562","article-title":"J Curve and Cuff Artefact, and Diagnostic Inertia in Resistant Hypertension","volume":"67","author":"Spence","year":"2016","journal-title":"Hypertension"},{"key":"2020050723410030000_3.2.69.23","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(72)90054-X"},{"key":"2020050723410030000_3.2.69.24","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-82-1-27"},{"key":"2020050723410030000_3.2.69.25","doi-asserted-by":"publisher","DOI":"10.1038\/ajh.2009.63"},{"key":"2020050723410030000_3.2.69.26","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1093\/ajh\/hpx066","article-title":"Physiological Phenotyping for Personalized Therapy of Uncontrolled Hypertension in Africa","volume":"30","author":"Akintunde","year":"2017","journal-title":"Am J Hypertens"},{"key":"2020050723410030000_3.2.69.27","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/ajh\/hpw167","article-title":"High Frequency of Variants of Candidate Genes in Black Africans with Low Renin-Resistant Hypertension","volume":"30","author":"Jones","year":"2017","journal-title":"Am J Hypertens"},{"key":"2020050723410030000_3.2.69.28","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.cjca.2014.01.018","article-title":"A single fixed-dose combination for all patients is bad medicine","volume":"30","author":"Spence","year":"2014","journal-title":"Can J Cardiol"},{"key":"2020050723410030000_3.2.69.29","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1038\/nrneurol.2010.114","article-title":"Secondary stroke prevention","volume":"6","author":"Spence","year":"2010","journal-title":"Nat Rev Neurol"},{"key":"2020050723410030000_3.2.69.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2011.11.010"}],"container-title":["Stroke and Vascular Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/svn-2017-000138","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T14:54:20Z","timestamp":1719845660000},"score":1,"resource":{"primary":{"URL":"https:\/\/svn.bmj.com\/lookup\/doi\/10.1136\/svn-2017-000138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,24]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,6,26]]},"published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1136\/svn-2017-000138"],"URL":"https:\/\/doi.org\/10.1136\/svn-2017-000138","relation":{},"ISSN":["2059-8688","2059-8696"],"issn-type":[{"value":"2059-8688","type":"print"},{"value":"2059-8696","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,24]]}}}