A person with high blood pressure has several medication and lifestyle change options to help lower their blood pressure. Doctors classify resistant hypertension as high blood pressure that does not respond to aggressive medical treatment.
Blood pressure is the pressure exerted by blood on the walls of the arteries. Hypertension, or high blood pressure, occurs when the pressure on the walls of the arteries is greater than it should be. Over time, the added pressure can damage the walls of a person’s arteries, which can lead to plaque buildup. This plaque buildup can end up partially or completely blocking blood flow, which can lead to heart disease or stroke.
The following article discusses resistant hypertension, its symptoms, possible causes, treatment.
Resistant hypertension: What is it?
Resistant hypertension is when a person’s high blood pressure does not improve when their blood pressure stays above their target and they take three blood pressure medications at the maximum dose, such as:
– long-acting calcium channel blockers
– angiotensin converting enzyme inhibitors
– angiotensin receptor blockers
– a diuretic
A doctor can diagnose resistant hypertension if a person needs four or more medications to reach their target blood pressure.
The following blood pressure values indicate high or high blood pressure:
Elevated: A systolic blood pressure of 120 to 129 millimeters of mercury (mm Hg) and a diastolic blood pressure of 80 mm Hg.
Stage 1 hypertension: a systolic blood pressure of 130-139 mm Hg or a diastolic blood pressure of 80-89 mm Hg.
Stage 2 hypertension: systolic blood pressure above 140 mm Hg or diastolic blood pressure above 90 mm Hg.
Symptoms are not always present. To find out if a person has high blood pressure, they should contact a healthcare professional to get checked out. However, if a person has a hypertensive crisis, they may suffer from headaches, chest pains, nosebleeds and shortness of breath. A doctor can diagnose resistant hypertension after 6 months of treatment with three blood pressure medications, when a person’s blood pressure has remained consistently high.
Causes of resistant hypertension
In most cases, the cause is unclear. Some cases of resistant hypertension occur as a result of secondary hypertension, which is hypertension that develops due to another medical condition. One of the common causes is primary aldosteronism, which is a group of disorders in which there is excessive production of aldosterone.
Aldosterone is a hormone that affects the body’s ability to regulate blood pressure. It sends signals to organs that increase the amount of sodium sent to the bloodstream, such as the kidneys.
Other common underlying causes may include:
– sleep problems, such as obstructive sleep apnea
– a buildup of plaque in the blood vessels that support the kidneys, which can lead to renal artery stenosis
– excessive alcohol consumption
– recreational drug use
– Abnormalities of the hormones that regulate blood pressure, such as hypothyroidism and hyperthyroidism.
If a secondary cause is not present, the cause is probably due to different factors.
About 10% of people with hypertension have a resistant form. Resistant hypertension shares the same risk factors as hypertension, namely:
– lack of activity or exercise
Treatment for resistant hypertension may vary depending on the suspected underlying cause. For example, if a doctor discovers that another medical problem is causing the high blood pressure, they will treat that problem in addition to trying to lower blood pressure.
Common treatment options include lifestyle modifications a person can make, including:
– stop smoking
– reduce alcohol consumption
– reduce sodium intake
– adopt a healthy diet
– physical activity
– to manage stress.
The doctor will also review the medications the person is taking and possibly suggest different combinations.
How to Diagnose Resistant Hypertension
To diagnose resistant hypertension, a doctor should:
– will perform a physical examination
– will take a complete anamnesis
– measure the patient’s blood pressure
– check for the presence of secondary conditions.
He can also check to see if any organ damage may have occurred due to high blood pressure using the following tests:
– electrocardiogram (ECG)
– chest X-ray
– urine analysis
– fundoscopy eye examination to check for damaged blood vessels in the eye.
Complications and prospects
High blood pressure can lead to stroke, heart failure, and heart attack.
Continuous high blood pressure can damage the walls of the arteries. Damaged arterial walls are more likely to develop plaque buildup. Once plaque has built up, it can cause partial or complete blockage. If the blockage occurs near the brain, it can cause a stroke. If the obstruction is near the heart, it can cause a heart attack.
A 2018 scientific publication notes that people with RH have a higher risk of developing:
– a myocardial infarction, or a heart attack
– a cerebrovascular accident (CVA)
– heart failure
– peripheral arterial disease.
If high blood pressure continues without successful treatment, a person has an increased risk of heart attack, stroke, and other potential problems over time.
A person living with resistant hypertension should work with a doctor to manage their hypertension. Successful management of the condition can help a person reduce the risk of developing other health problems.
Pseudo-resistant hypertension is high blood pressure that seems to resist treatment. However, pseudoresistant hypertension occurs when either:
– a doctor or person has inaccurate blood pressure readings that are high
– use of the wrong drug, ineffective dosage or lack of adherence to treatment.
– More accurate blood pressure measurements, medication adjustments or better adherence to treatment on the part of the person can help improve the situation.
When to contact a doctor
A person should tell a doctor if their home blood pressure readings remain elevated despite taking prescribed medications and lifestyle changes. Continuous high levels could indicate the source is an underlying condition. One should consider getting a home blood pressure monitor. This device can allow him to monitor his own blood pressure. Finally, a person should contact a doctor if any new or worsening symptoms occur. She should seek emergency medical help if she has symptoms of a heart attack or stroke.
Resistant hypertension is when blood pressure remains high despite taking three Safe Source blood pressure medications at their maximum dose, or when a person needs to take four or more to reach their blood pressure goal. In a small number of cases, hypertension is due to an underlying condition. The majority of cases have no known cause. After receiving a diagnosis, a person can work with a doctor to adjust their medications and discuss other lifestyle changes that might help.