Managing Resistant Hypertension

Resistant hypertension is defined as poorly controlled blood pressure (BP) despite the patient being on three or more types of antihypertensive medications (one ideally being a diuretic) at optimal doses. This form of hypertension occurs in less than 10% of hypertensive patients. Fortunately, there is help for people suffering from high blood pressure that is hard to control, even with multiple medications.

Possible causes of resistant hypertension

Resistant hypertension may be caused by one or more underlying medical conditions. Heart doctors typically investigate the following secondary causes:

• Abnormalities in the hormones that control blood pressure
• Renal artery stenosis (accumulation of artery-clogging plaque in blood vessels that nourish the kidneys)
• Sleep problems (such as obstructive sleep apnoea)
• Obesity or heavy intake of alcohol or other substances that can interfere with blood pressure

Why is it dangerous?

Studies have shown that people with resistant hypertension are at greater risk of experiencing two cardiovascular conditions at the same time compared to patients with non-resistant hypertension. These conditions include ischaemic heart disease, congestive heart failure and chronic kidney disease.

Monitoring hypertension

Controlling BP levels starts from understanding your pressure patterns. This can be done by wearing a pager-sized automatic BP recorder for 24 hours or checking your BP level with a home monitor several times a day.

Treatment usually involves diagnosis and alleviation of secondary causes, a change or addition of medications, as well as lifestyle modification. These include:

• Consuming a well-balanced, low-salt diet
• Limiting alcohol intake
• Enjoying regular physical activity
• Maintaining a healthy weight
• Managing stress
• Taking medications properly

People with resistant hypertension should take the right medications in the right doses and at the right time. Avoid certain medications or supplements that can raise BP levels and worsen BP control, such as nonsteroidal anti-inflammatory drugs (NSAIDs), diet pills, decongestants, glucocorticoids, corticosteroids, licorice and more.