Heart Health Series - Part 4 - Resistant Hypertension

One out of seven patients being treated for high blood pressure do not have controlled BP, despite taking three or more BP medications, including a diuretic, according to American Heart Association. This can silently affect the heart health, before you know, by leading to a stroke or a heart attack.

"Many cases of alleged resistant hypertension occur because people don't take their medications as prescribed, for various reasons," says Dr. Randall Zusman, a cardiologist at Harvard-affiliated Massachusetts General Hospital.

Reasons: This condition of resistant hypertension may be due to:

• Habits that counter the effects of blood pressure drugs
• Undiagnosed medical conditions, or
• Not taking medications as prescribed, for various reasons.

Medication for High Blood Pressure: There are more than 200 different drugs to treat high blood pressure according to Harvard Medical School. The drugs prescribed by your doctor may depend on other medical conditions you may have, such as Angina or Atrial Fibrillation. The drugs fall into several classes, including:

• Diuretics
• ACE inhibitors and ARBs
• Calcium-channel blockers
• Beta blockers
• Aldosterone blockers.

Irregular Medication

Skipping doses is one of the main causes for your heart rate and blood pressure to rise, putting your heart at risk. People may skip doses because of side-effects caused by medication which can be sorted out by talking to their doctor.

Self-managing your drug regimen can be risky. Different medications have different modes of action and the specific combination is what drives down their blood pressure. Abruptly stopping a beta blocker can cause your heart rate and blood pressure to rise, putting your heart at risk.

Often (daily or several times a week) taking over-the-counter pain killers such as non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen, can also raise blood pressure. Talk to your physician about the best option for your need.

Correct dose and the right medication are critical to controlling high blood pressure.

Diet Issues

“A high-sodium diet interferes with commonly prescribed blood pressure drugs, making them less effective," says Dr. Zusman. Cutting down on processed and restaurant-prepared foods (the biggest contributors of sodium) can help to make BP medication more effective.

Secondary Causes

Sometimes, an underlying medical condition may elevate your blood pressure. People who suffer from resistant hypertension may have the following conditions or more:

• Excessive aldosterone hormone that holds on to sodium and water but lose potassium.
• Renal artery stenosis - a narrowing of the arteries supplying the kidneys; and
• Obstructive sleep apnea – blocking of the upper airway during sleep, causing pauses in breathing.

“People with resistant hypertension are far more likely than the general public to have one of these conditions”, says Dr. Zusman.

Standard Recommendations:

• Preventing excessive sodium intake and increasing the intake of fruits and vegetables.
• Cutting down on alcohol to less than two alcoholic drinks per day if you're male or, one drink per day if you're female.
• Getting at least 30 minutes of moderate exercise, 5 days a week.

These habits have the added benefit of helping you maintain a healthy weight that also helps control blood pressure.