What is Resistant Hypertension?
A person with high blood pressure takes several medications and introduces lifestyle changes that help in reducing the raised blood pressure reading.
Resistant hypertension is a condition in which a person does not respond to any medical treatment and the blood pressure reading is difficult to be brought to acceptable levels.
Blood pressure is the amount of pressure placed by blood against the artery wall that is more than usual. This extra pressure can damage the artery wall and lead to plaque build-up. This plaque build-up can partially or fully block the flow of blood and lead to heart disease or stroke.
To improve the blood pressure, medications are given, which if taken in a high dose for a long, lead to resistant hypertension. The medications include:(1)
- Angiotensin recept blocker
- Diuretics
- Angiotensin-converting enzyme inhibitors
- Long-acting calcium channel blockers
Resistant hypertension is diagnosed if a person needs four or more medications to achieve the blood pressure target.
What Causes Resistant Hypertension?
In most cases of resistant hypertension, the reason for occurrence is unclear.(2)
In some cases, resistant hypertension occurs due to secondary hypertension that develops due to another medical condition. A common condition is aldosteronism, a condition in which there is a high level of aldosterone in the body.(1) Aldosterone plays a role in affecting the ability of the body to regulate blood pressure. It sends signals to the organs that increase the amount of sodium in the blood.
The other common causes that may lead to resistant hypertension include:
- Heavy drinking
- Obstructive sleep apnea and other sleep issues
- Use of recreational drugs
- Obesity
Abnormalities that regulate blood pressure such as hyperthyroidism and hypothyroidism.
Risk Factors of Resistant Hypertension
About 10% of people with hypertension have resistant hypertension and share common risk factors including:(2)
Symptoms of Resistant Hypertension
Someone with resistant hypertension does not always have symptoms. One has to get the blood pressure checked by a healthcare professional to see if it’s raised.
Having high blood pressure for a longer period of time may lead to nose bleed, chest pain, shortness of breath and headache.
A diagnosis for resistant hypertension is given if a person’s blood pressure remains high despite taking different medications for a period of 6 months.
Diagnosis of Resistant Hypertension
The diagnosing of resistant hypertension involves the following:
Performing physical examination
Taking full history
Measuring a person’s blood pressure
Testing for other conditions
The doctor may also look for organ damage by performing the following tests:
- Electrocardiogram
- X-ray of the chest
- Urinalysis
- Echocardiogram
- Fundoscopic eye examination
Treatment of Resistant Hypertension
The treatment for resistant hypertension may vary depending on the cause. If any underlying medical condition is causing resistant hypertension, the doctor would go ahead with treating that condition.
The common treatment option includes lifestyle changes, such as:
- Quitting smoking
- Eating a healthy diet
- Reducing alcohol intake
- Reducing sodium intake
- Managing stress
- Physical activity
Complication and Outlook of Resistant Hypertension
Hypertension may lead to stroke, heart failure, and heart attack. Continuous high blood pressure may lead to damage to the artery wall making it more likely to develop plaque build-up. This may lead to partial or full blockage. If the blockage is near the heart, the risk of heart attack is more.
Those with resistant hypertension have more risk of developing:
It is important for a person with resistant hypertension to work with a doctor and manage the condition.
A person with consistently high blood pressure should talk to the doctor and follow lifestyle changes. A home blood pressure monitor should be kept. The doctor should be informed about the new symptoms experienced and also should seek emergency condition help if any symptoms of heart attack or stroke are experienced.
Once a diagnosis is obtained the main focus should be on improving the blood pressure with the medications discussed with the doctor and the lifestyle changes.
