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Management of Resistant Hypertension and recent trends

Resistant hypertension occurs when high blood pressure fails to respond well to aggressive medical treatment. Blood pressure is the force of blood pushing against the artery walls. This force is generated by each heartbeat as blood gets pumped from the heart into the blood vessels. Blood pressure is also affected by the size, tone, and elasticity of the artery walls. The kidneys are where the blood pressure is monitored by regulating the amount of fluid and salts in the body.

The prognosis of resistant hypertension is unknown, but the cardiovascular risk is undoubtedly increased as patients often have a history of long-standing, severe hypertension complicated by other or multiple cardiovascular risk factors such as obesity, diabetes, chronic kidney disease, and sleep disorders.

While the exact prevalence of this condition is not known, clinical trials suggest that it is not rare, involving around 20% to 30% of study participants. Older age and obesity are found to be the strongest risk factors for uncontrolled hypertension. The incidence of resistant hypertension is likely to increase when the population becomes more elderly and heavier.

When does hypertension get resistant? Hypertension is considered resistant when all of the following are proven true:

  • A patient is taking three different blood pressure medications at their maximally tolerated doses
  • One of the blood pressure medications is a diuretic (elimination of fluid and salts from the body)
  • Blood pressure remains higher than it is supposed to be (usually 130/80 mmHg, irrespective of individual goals)
  • Hypertension requires four or more medications to be controlled

If this hypertension is left untreated, it will substantially increase the risk of heart attack, stroke, and even kidney failure.

Hence, due to the mortality and comorbidity caused by resistant hypertension, this condition is also known as the silent killer. That’s because most of the hypertensives do not know that they have hypertension. However, suddenly after 15 to 25 years of undiagnosed hypertension, they land up with a stroke or heart failure or even death.

Looking at the current numbers, the world population is around 8 billion and there are more than 970 million hypertension patients across the globe. When it comes to our country, the population of India is more than 1.3 billion and there are around 208 million people affected by hypertension, of which 30% is the incidence in the urban population and 15% in the rural population.

Still, many people are unaware of hypertension, let alone resistant hypertension. Hence, it is very important for clinicians and specialists to take all possible measures and create maximum awareness about resistant hypertension.

The condition is further detailed in a special webinar on resistant hypertension and its prevalence in India. Understand more about the diagnosis, treatment, and important drugs to treat resistant hypertension – Click here

Dr. J Ezhilan, Senior Consultant Cardiologist at the Madras Medical Mission Hospital, Chennai


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