Resistant hypertension is highblood pressurethat do not respond well to aggressive medical treatment.Hypertensionconsidered resistant if all of the following are true:
- Someone takesthree* different blood pressure medicationsin the maximum tolerated doses.
- One of the blood pressure medications is adiuretic(removes fluid and salt from the body).
- Blood pressure remains above your target range—(usually 130/80 mmHg, although individual targets should be discussed with your doctor)
- If hypertension requires itfireworkor multiple medications that need to be controlled is also called resistant hypertension.
Resistant hypertension significantly increases the risk of heart attack, stroke and kidney failure.
What is hypertension (high blood pressure)?
Blood pressure is the force with which the blood pushes against the artery walls. The force is generated by each heartbeat as blood is pumped from the heart into the blood vessels. The size, tone and elasticity of the artery walls also affect blood pressure. The kidneys also regulate blood pressure by regulating the amount of fluid and salt in the body.
HypertensionAn average arterial blood pressure during a normal day is said to be 130/80 mmHg or higher.Hypertensiongradually damages the walls of large arteries (aorta, carotid arteries) and smaller ones (cerebral, coronary, renal, retinal) and causes the heart to work harder to pump blood around the body.
What are the symptoms of resistant hypertension?
You can have hypertension without having any symptoms. The best way to know if you have high blood pressure is to have your blood pressure checked by a healthcare provider.
However, symptoms may be felt when blood pressure first rises or falls below 1hypertensieve crisis, when levels are extremely high. These symptoms may include headache, shortness of breath, chest pain and nosebleeds.
Dizzinessis normaldoesn'ta symptom of high blood pressure. Dizziness can even sometimes be a symptom of diabeteslavablood pressure. Frequent or unexplained dizziness may be a warning sign of a serious condition and should be treated by your doctor.
What are the risks of resistant hypertension?
Over time, uncontrolled hypertension damages the arteries, contributing to their stiffness. As the arteries become narrower and less flexible, the heart has to work harder to keep blood flowing throughout the body. Uncontrolled high blood pressure can lead to:slak,heart attack,heart failureand other heart diseases; cause damage to youkidneys,memoryInvision; and contribute toerectile dysfunction.
What causes resistant hypertension?
Underlying medical causes
In approximately 25 percent (1 in 4) of people with resistant hypertension, there is an identifiable or secondary cause. People whose blood pressure is elevated due to a medical condition are said to have thissecondary hypertension. Secondary hypertension will be very difficult to control until these conditions are treated.The more resistant the hypertension, the more likely there is a secondary cause.
Some common secondary causes of hypertension include:
Structural disorders
- Sleep apnea, a tendency to stop breathing for seconds during sleep
- Renal artery stenosis (kidney)., a narrowing of the artery that sends blood to the kidneys
- Coarctation of the aortaa narrowing of part of the aorta (artery that sends blood from the heart to the rest of the body)
- Kidney failure
Hormonal disorders
- Primary aldosteronism, aadrenalcondition that increases blood pressure.
- Feochromocytoom, a tumor of the adrenal gland that produces too much adrenaline and/or other hormones that increase blood pressure
- Hyperthyroidism(overactive thyroid) andhypothyroidism(underactive thyroid) can both increase blood pressure
- Cushing's disease, often due to a tumor in the pituitary gland that causes overproduction of cortisol, the 'stress hormone'
- Other, rarer congenital neuroendocrine diseases
Unknown triggers
In the remaining 75 percent of people with resistant hypertension, there is no known medical cause. It is said that these people did thatprimaryofessential hypertension, and their treatment will focus on medication and lifestyle management.
How is resistant hypertension diagnosed?
- Complete history and physical examination, including telling your doctor about all medications and supplements, whether prescription, over-the-counter, herbal, or recreational. It is important to mention if you miss doses of daily medication.
- Real measurement of your blood pressureusing the correct technique and calibrated equipment.
- Blood pressure measurement at home during the day and 24-hour ambulatory blood pressure monitoringto record your blood pressure during a normal day. It can be used if your doctor suspects that your office blood pressure readings are not telling the whole story.
- Test for secondary conditions, which may include special blood tests and imaging tests. Identifying and treating these conditions can eliminate hypertension or at least make it more treatable.
- Tests for organ damage caused by hypertension, which may include:
- Electrocardiogramto measure the size and rhythm of your heart
- Echocardiogramto measure the size and function of your heart
- Fundoscopic eye examination to check for damaged blood vessels in the eye; these small blood vessels enter from the brain and are a unique opportunity for your doctor to assess the health of similar blood vessels in your brain, heart, and kidneys
- Urinalysis to check for kidney damage
- Other blood tests (genetic tests for rare conditions)
- Chest x-ray
How is resistant hypertension treated?
Treatment options for resistant hypertension or pseudoresistant hypertension (described below) depend on your underlying conditions and how well you tolerate different medications. Treatments include:
- Management of any conditions that may have caused the hypertension.
- Make lifestyle changes
- Adjustment of medication to find your optimal type and dosage
What is pseudo-resistant hypertension?
Pseudoresistant (apparently resistant) hypertension is high blood pressure that appears to be resistant to treatment, but other factors actually interfere with proper treatment or measurement. Specifically:
- Wrong medicine or wrong dose
- Medicines and nutritional supplements
- Lifestyle factors
- Wittejaseffect
- Strengthening of the arteries
- Inadequate measuring technique
It is also very important to diagnose pseudoresistant hypertension as true resistant hypertension, because both conditions increase the risk of heart attack and stroke.
Wrong medicine or wrong dose
For each person there is an ideal combination of medications and dosages that can best control high blood pressure. Some people have yet to receive the ideal combination. It is important to work with a doctor who is familiar with the range of medications and who knows what works best for the individual.
Medicines and nutritional supplements
Many medications and nutritional supplements increase blood pressure. Examples include various painkillers, antidepressants, decongestants, high doses of aspirin and birth control pills. Stimulants – from caffeine and ADHD drugs to cigarettes – as well as recreational drugs and excessive alcohol consumption can also increase blood pressure. That includes many "natural" or "herbal" supplements, as well as sweets or drinks containing licorice.
It is important that you give your doctor a full picture of the medicines and supplements you are taking, whether you take them every day or only occasionally.
Lifestyle factors
Your lifestyle may make high blood pressure difficult to control, or may have caused it in the first place. Taking blood pressure medication without changing your habits means that your medication lowers your blood pressure, while your actions raise it. Such actions may include:
- Skipping your medication: When you take an aspirin and your headache goes away, you know the aspirin is working. But hypertension doesn't cause any symptoms, so you may be less motivated to take your blood pressure medication every day, causing your body to suffer the damage caused by high blood pressure over time.
- Eating too much sodium (salt).: Sodium increases blood pressure. Most Americans get too much salt from processed foods. Learn simple steps to reduce salt in your diet.
- Smoking cigarettes: Smoking narrows and hardens your blood vessels, causing blood pressure to rise. Talk to your doctor about how to quit smoking.
- Hanging around: Exercise strengthens your heart so it can pump more blood with less effort. The good news: 40 minutes of aerobic exercise four times a week can lower your blood pressure as much as some medications.
- Drinking too much alcohol. Alcoholic drinks increase blood pressure if consumed frequently.
White-Coat-effect
Many people have higher blood pressure at the doctor's office than during their normal day. If your doctor suspects the white coat effect, you may need to wear a small, portable 24-hour blood pressure monitor to see what your pressure looks like over time during your daily activities, or measure your blood pressure at home with an automated device.
Strengthening of the arteries
Some doctors believe that the most authentic form of pseudo-resistant hypertension is caused by stiffened brachial arteries that prevent the blood pressure cuff from getting an accurate reading. If your doctor suspects this type of pseudo-resistant hypertension, they may consider other ways to measure your blood pressure.
Inadequate measuring technique
Although it sounds simple, blood pressure can be measured incorrectly and home blood pressure monitors may not be properly calibrated. Your healthcare provider will need to take several factors into account, such as the size of your arm and the position of your body during the measurement.
