World Hypertension Day 2024: What is resistant hypertension; the condition that doesn’t respond well to medications?

What is resistant hypertension?

“Resistant hypertension is a challenging condition characterised by high blood pressure that does not respond adequately to standard medications. It is defined as persistently elevated blood pressure levels that remain above the target range despite the use of three or more antihypertensive medications, including a diuretic. This condition can significantly increase the risk of cardiovascular complications such as heart disease, stroke, and kidney damage if left uncontrolled,” says Dr. V. Rajasekhar, Senior Consultant Interventional Cardiology & Electrophysiology, Certified Proctor For TAVR & Clinical Director, Yashoda Hospitals Hyderabad.

“Patients should see their physician, who will investigate them for causes of secondary hypertension like renal artery stenosis, Phaechromocytoma, and Primary hyperaldosteronism if required. Obese patients very often have obstructive sleep apnea, which is a common cause of uncontrolled Hypertension. Uncontrolled hypertension leads to renal failure and heart failure and is a leading cause of strokes and vision loss,” says Dr Sundari Shrikant, Director of Internal Medicine at Marengo Asia Hospitals, Faridabad.

Causes of resistant hypertension

“Usual causes are poor compliance with medication, alcohol use, frequent use of painkillers and cough syrups, obesity and kidney dysfunction, says Dr. Shrikant.

Several potential causes of resistant hypertension need to be addressed for effective management.

“One common reason is non-adherence to the prescribed medication regimen. Skipping doses or not taking medications as directed can lead to uncontrolled blood pressure levels. Inadequate treatment regimens, secondary causes of hypertension (such as kidney disease or hormonal disorders), and lifestyle factors like obesity, excessive alcohol consumption, or high salt intake can also contribute to the development of resistant hypertension,” adds Dr Rajasekhar.

How to manage resistant hypertension

Managing resistant hypertension requires a comprehensive approach that involves lifestyle modifications, medication adjustments, and addressing underlying causes.

“Lifestyle changes such as adopting a healthy diet low in sodium, engaging in regular physical activity, maintaining a healthy weight, and reducing alcohol consumption can help lower blood pressure levels. Identifying and treating any underlying conditions contributing to high blood pressure is also crucial for effective management,” adds Dr Rajasekhar.

“Medication adjustments are often necessary in cases of resistant hypertension. Healthcare providers may need to modify the current medication regimen, add new medications, or consider alternative treatment options for better blood pressure control. Renal artery Denervation is a new treatment modality that effectively addresses the problem of resistant hypertension. In this procedure, the hyperactive nerves around the kidneys are ablated by radio frequency energy thereby helping control blood pressure,” he says.

Regular monitoring of blood pressure levels is essential to tracking the effectiveness of treatment and making necessary adjustments as needed.

“Stop smoking and drinking, lose weight, and avoid fried and processed food. Increase your intake of fresh fruits and reduce your salt intake. Regular exercise and regular intake of bp medication will keep bp under control,” says Dr Shrikant.