Hypertension is a key public health issue and it globally affects more than one billion individuals. Also known as blood pressure, hypertension occurs when blood exerts force against the walls of the blood vessels. It is defined as, ‘transitory or chronic elevation of blood pressure in the arteries’. This elevation may result in cardiovascular damage. When the blood pressure is below 120/80, it is classified as normal, whereas hypertension happens when it reaches above 140/90. Resistant hypertension, a form of hypertension, is defined as, ‘Blood pressure that remains above goal despite the concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic (1-3)’. If a patient is taking three or more medications to manage and control hypertension, including a diuretic in optimal doses, they are said to have resistant hypertension.

Symptoms and Causes of Resistant Hypertension

Hypertension may not always lead to symptoms and getting your blood pressure checked at your local clinic is the ideal way to know if you have hypertension. A hypertensive crisis during extremely high levels of blood pressure can signify that you have hypertension. Symptoms can also be felt when blood pressure rises for the first time. They could include shortness of breath, blurred vision, nosebleeds, blood in the urine, headaches, irregular heartbeat, confusion and pounding in the chest, neck or ears.

A patient develops resistant hypertension due to improper adherence to the prescribed anti-hypertensive medication, inadequate medication, physician inertia, improper combinations of medications, volume overload and secondary hypertension. The most common secondary causes of resistant hypertension, mostly found in old patients are drug-induced.

Lifestyle factors leading to hypertension include excessive salt intake, obesity, inordinate alcohol intake, physical inactivity. Blood pressure control is more difficult to achieve in obese patients than in lean patients. Due to excessive alcohol intake (more than 3 drinks per day), many drinkers develop hypertension. The risk factors for hypertension are diabetes, smoking, chewing tobacco, high cholesterol and lack of physical exercise.

Prevalence of Hypertension in India

According to a study, one in five young adults in India have hypertension, that is the equivalent of about 80 million people.  The Great India BP survey was conducted in 24 Indian states and participants were asked about the risk factors for hypertension and whether they were taking medication. Another survey (National Family Health Survey) conducted in 2017 found that about 8.6 percent of India’s population (10.4 percent men, 6.7 percent women) has high blood pressure. Hypertension rates were found to be higher in urban areas, as compared to rural regions in India. Indians rarely indulge in physical activity and the diets in India contain large amounts of fat and salt. This has led to an increase in cases of hypertension.

Importance of a Good Diet, Health Screening and Management

Routine blood pressure tests must be conducted by physicians every time a patient visits them.  They must start screening patients for hypertension at 18–19 years of age, to prevent and treat the condition effectively. After screening them for hypertension, doctors usually recommend both dietary and medical solutions. Awareness drives must be conducted in India to ensure that people undergo routine blood pressure checkups. Repeated screenings have been recommended by cardiologists to eliminate wrong diagnosis, unnecessary treatment or any other complications.  Physicians can evaluate patients for resistant hypertension before referring them to specialized hypertension clinics. Techniques to test for resistant hypertension include assessment of adherence, BP measurement through correct techniques, examination to determine severity, ambulatory BP monitoring, biochemical evaluation and non-invasive imaging.

Management and treatment of resistant hypertension are usually done through aggressive lifestyle changes like maximizing adherence, weight management, dietary salt restriction, increased physical exercise, moderation or cessation of alcohol intake and dietary interventions. Treatment of secondary causes like obstructive sleep apnea, renal artery stenosis can help manage the condition. Pharmacological treatments like the elimination of interfering medications, diuretic therapy, proper dosage, combination therapy and referrals to specialists are another way to treat and manage resistant hypertension.

 

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