Breaking barriers: from pseudoresistance to efficient control of blood pressure
DOI: 10.32364/2587-6821-2026-10-9-2
Breaking barriers: from pseudoresistance to efficient control of blood pressure
O.D. Ostroumova1,2, A.I. Kochetkov1, A.V. Dubinina1, S.S. Telkova1
1 Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
2 Sechenov First Moscow State Medical University, Moscow, Russian Federation
Arterial hypertension (AH) is a key modifiable risk factor for cardiovascular complications. At the same time, a lack of blood pressure control is reported in AH patients. In general, non-compliance with target values is associated with pseudoresistance based on low adherence to therapy, metabolic syndrome and hypervolemia. In this setting, a rational choice of combined antihypertensive therapy requires simultaneous suppression of the renin-angiotensin-aldosterone system and adjustment of volemic status. Chlortalidone, one of the key representatives of thiazide-like diuretics, is characterized by a longer half-life providing a stable 24-hour antihypertensive effect and a proven decrease in a risk of stroke and heart failure (including that associated resistant AH). Unlike other angiotensin II receptor blockers, azilsartan medoxomil demonstrates the most stable and strongest antihypertensive effect, as well as beneficial metabolic effects partially mediated by agonism to PPAR-γ receptors. The combination of azilsartan medoxomil and chlortalidone affects key pathogenetic mechanisms of hypertension in comorbid patients contributing to achieving target blood pressure levels, increasing adherence to the therapy, and improving long-term cardiovascular prognosis.
Keywords: arterial hypertension, resistant hypertension, chlortalidone, azilsartan medoxomil, metabolic syndrome, angiotensin II receptor blockers, thiazide-like diuretics.
For citation: Ostroumova O.D., Kochetkov A.I., Dubinina A.V., Telkova S.S. Breaking barriers: from pseudoresistance to efficient control of blood pressure. Russian Medical Inquiry. 2026;10(9):600–607 (in Russ.). DOI: 10.32364/2587-6821-2026-10-9-2
About the authors:
Olga D. Ostroumova — Professor, Dr. Sc. (Med.), Head of the Academician M.S. Vovsi Department of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education; 2/1, bldg. 1, Barrikadnaya str., Moscow, 125993, Russian Federation; Professor of the Department of Clinical Pharmacology and Propedeutics of Internal Diseases, Sechenov First Moscow State Medical University; 8, bldg. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0002-0795-8225
Svetlana S. Telkova — Assistant, Senior Assistant of the Academician M.S. Vovsi Department of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education; 2/1, bldg. 1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0003-1439-7371
Anna V. Dubinina — Postgraduate Student, Academician M.S. Vovsi Department of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education; 2/1, bldg. 1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0009-0008-6383-0016
Alexey I. Kochetkov — C. Sc. (Med.), Assistant Professor, Assistant Professor at the Academician M.S. Vovsi Department of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education; 2/1, bldg. 1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0001-5801-3742
Contact information: Olga D. Ostroumova, e-mail: ostroumova.olga@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 17.07.2026.
Revised 11.08.2026.
Accepted 31.08.2026.
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4. Liu X., Wang X., Liang Y. et al. Global pattern, trend, and cross-country inequality of cardiovascular diseases caused by hypertension from 1990 to 2021, with projection from 2022 to 2060. Am J Prev Cardiol. 2025;24:101350. DOI: 10.1016/j.ajpc.2025.101350
5. Кобалава Ж.Д., Конради А.О., Недогода С.В. и др. Артериальная гипертензия у взрослых. Клинические рекомендации 2024. Российский кардиологический журнал. 2024;29(9):6117. DOI: 10.15829/1560-4071-2024-6117. Kobalava Zh.D., Konradi A.O., Nedogoda S.V. et al. 2024 Clinical practice guidelines for Hypertension in adults. Russian Journal of Cardiology. 2024;29(9):6117 (in Russ.). DOI: 10.15829/1560-4071-2024-6117
6. Бочкарев М.В., Коростовцева Л.С., Бояринова М.А. и др. Факторы, ассоциированные с успешностью контроля артериальной гипертензии: анализ данных исследования ЭССЕ-РФ. Артериальная гипертензия. 2025;31(6):574–585. DOI: 10.18705/1607-419X-2025-2575. Bochkarev M.V., Korostovtseva L.S., Boyarinova M.A. et al. Factors associated with successful blood pressure control: data from the ESSE-RF study. Arterial Hypertension. 2025;31(6):574–585 (in Russ.). DOI: 10.18705/1607-419X-2025-2575
7. Li Y., Lan C., Wang Y. et al. Prevalence of and associated factors for resistant hypertension in primary care settings: a systematic review and meta-analysis. BMC Public Health. 2026;26:1728. DOI: 10.1186/s12889-026-27373-6
8. Подзолков В.И., Брагина А.Е., Осадчий К.К. Резистентная гипертензия: вопросы и современные ответы. Рациональная фармакотерапия в кардиологии. 2019;15(4):568–577. DOI: 10.20996/1819-6446-2019-15-4-568-577. Podzolkov V.I., Bragina A.E., Osadchiy K.K. Resistant hypertension: questions and modern answers. Rational Pharmacotherapy in Cardiology. 2019;15(4):568–577 (in Russ.). DOI: 10.20996/1819-6446-2019-15-4-568-577
9. Park S., Shin J., Ihm S.H. et al. Resistant hypertension: consensus document from the Korean society of hypertension. Clin Hypertens. 2023;29(1):30. DOI: 10.1186/s40885-023-00255-4
10. Naydenov S., Manov E., Runev N. Prevalence, Clinical Characteristics, and Treatment of Patients with Resistant Hypertension: A Single-Center Study. J Cardiovasc Dev Dis. 2024;11(9):279. DOI: 10.3390/jcdd11090279
11. Azizi M., Vongpatanasin W., Fisher N.D.L. et al. Diagnosis and Management of Resistant Hypertension: A Review. JAMA. 2026;335(16):1428–1439. DOI: 10.1001/jama.2026.1221
12. Kulach A., Stachowiak P., Prasal M. et al. A questionnaire-based, multicenter registry of resistant and pseudo-resistant arterial hypertension. Wiad Lek. 2019;72(10):1866–1871. DOI: 10.36740/WLek201910102
13. Hernandez del Rey R., Armarioa P., Martín-Baranerab M., Castellanos P. Clustering of cardiovascular risk factors and prevalence of metabolic syndrome in subjects with resistant hypertension. Med Clin (Barc). 2006;127(7):241–245. DOI: 10.1157/13091263
14. Chaudhary K., Buddineni J.P., Nistala R., Whaley-Connell A. Resistant hypertension in the high-risk metabolic patient. Curr Diab Rep. 2011;11(1):41–46. DOI: 10.1007/s11892-010-0155-x
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