Is your blood pressure not controlled by medication? Let's talk about 'Resistant Hypertension'!

Do you know, sometimes even though we take medicine for our blood pressure, there are times when it is very difficult to control it. Do you feel like your blood pressure is not decreasing even after changing the medicine given by the doctor one by one? You are not the only one, there are people who face this situation. So today we will talk about this condition called ``Resistant Hypertension``.

What is this 'resistant hypertension'?

Simply put, 'resistant hypertension' is when your blood pressure, to be precise, is consistently at 140/90 millimeters of mercury (140/90 mmHg) or higher - even if you're taking at least three types of blood pressure medication at maximum doses. These three types of medication usually include:

• One diuretic (we call it " water pills ").
• One calcium channel blocker.
• An angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB).

High blood pressure, or "pressure" as we all know it, is a major health problem that increases the risk of cardiovascular diseases (heart and blood vessel diseases). Can you imagine, if your blood pressure is not controlled after six months of consistent treatment, doctors start to suspect that you have "uncontrolled high blood pressure." Clinical studies are underway to find new treatments that could help people with this condition in the future.

How common is 'uncontrolled high blood pressure'?

According to data from the United States, about 29% of adults have high blood pressure . Of those , approximately 12% fall into the category of 'uncontrolled high blood pressure.' It seems that this situation is not insignificant in Sri Lanka either.

What are the symptoms of this?

Imagine, some people don't even know they have high blood pressure for years. However, untreated high blood pressure can be very dangerous to your health . Even if you don't always have symptoms, some people have experienced things like headaches, chest tightness, or shortness of breath . Therefore, you and your doctor should always be aware of your blood pressure, especially as you get older. You can measure your blood pressure at home with a good, affordable electronic blood pressure monitor. You can find such a device at a pharmacy or online.

Why does this 'uncontrolled hypertension' occur? What are the reasons?

There can be a number of reasons why 'uncontrolled high blood pressure' occurs. These can range from your lifestyle, certain medications you take, or even other medical conditions you have.

Lifestyle and food

The following can contribute to both high blood pressure and 'uncontrolled high blood pressure':

• Your Body Mass Index (BMI) is over 25 (which means you have excess body fat).
• Lack of physical activity (not exercising).
• Eating too much salt (this is a problem for many people!).
• Excessive alcohol consumption.

Some medications

Some of the medications you take, both prescription drugs and over-the-counter (OTC) drugs, can make it harder to control your blood pressure. For example:

• Painkillers , especially those called ``NSAIDs - Nonsteroidal Anti-inflammatory Drugs)``. For example ``( Ibuprofen )`` and ``( Naproxen )``.
• Nasal decongestants.
• Oral contraceptives (birth control pills).
• Some herbal products like Ginseng and Licorice.

Other underlying medical conditions (Secondary causes)

Sometimes, other treatable underlying medical conditions can be the cause of your 'uncontrolled high blood pressure'. We call these secondary causes. Here are a few examples:

• Primary hyperaldosteronism: This is when your adrenal glands produce too much of certain hormones .
• Renal artery stenosis: This is a narrowing of the arteries that supply blood to your kidneys.
• Chronic kidney disease ( CKD ).
• Sleep apnea.
• Pheochromocytoma: A tumor that forms in your adrenal gland (this is somewhat rare).
• Aortic narrowing (this is also rare).
• Cushing syndrome: Excessive production of certain steroid hormones (this is also rare).

Who is at higher risk of developing 'uncontrolled hypertension'?

The following people are more likely to develop 'uncontrolled high blood pressure':

• For those with chronic kidney disease.
• For those with diabetes.
• For black Americans, ``African American'' (this is something found in American studies).
• For women.

What complications can arise from this condition?

Compared to people with high blood pressure but with it under control, people with 'uncontrolled high blood pressure', which is not easily controlled with these treatments, are at higher risk :

• Stroke.
• Kidney disease may occur.
• Heart failure may occur.

This is something to remember: This shows how important it is to control your blood pressure, doesn't it?

How do doctors diagnose this 'uncontrolled high blood pressure'?

To diagnose 'uncontrolled high blood pressure', your doctor will collect a lot of information from you. They will want to confirm the following:

• Have your blood pressure values ​​been measured correctly ?
• Are you taking the prescribed medication correctly every day ?
• Do you have a condition called "white coat syndrome" (meaning your blood pressure only increases when you go to the doctor).

Asking about your medical history

Your doctor may ask things like:

• When did you start having high blood pressure?
• What steps do you take when you check your blood pressure at home?
• What medications (including herbs and supplements) are you currently taking, and are you taking them as prescribed?
• Questions about secondary causes that may be contributing to your uncontrolled high blood pressure.
• Questions about alcohol and tobacco use.

Physical examination

The physical examination looks for these things:

• Abnormal changes in your eyes (this is called hypertensive retinopathy).
• Abnormal sounds heard through some of the major arteries (called bruits - vascular murmurs). These sounds indicate that these blood vessels may have abnormal deposits of fat, called plaques.

Lab tests

Laboratory tests may include:

• A urine test to see if there is protein in the urine.
• Blood tests check the levels of creatinine, glucose, and electrolytes like sodium and potassium in your blood.
• A blood test to check for adrenal gland or kidney disease.
• Get tested for thyroid disease, as a condition called hypothyroidism can contribute to high blood pressure.

Imaging tests

You can have these tests done to check your adrenal glands or to see if your renal arteries are narrowed:

• X-rays.
• Ultrasound tests.
• CT scan `(Computed tomography - CT scans)`.

Your doctor may also recommend a sleep study to see if you have sleep apnea.

How do you control this 'uncontrolled high blood pressure'? What are the treatments?

Lifestyle changes and medications can be used as treatments for 'uncontrolled high blood pressure'.

Lifestyle changes

The changes you can make are:

• Limiting salt (eating less than 2,400 milligrams per day) and limiting alcohol.
• Limit the use of NSAIDs as painkillers and use something like paracetamol (Acetaminophen) instead.
• Engage in aerobic activity outdoors for at least 30 minutes a day, several days a week.

Medicines

Treating 'uncontrolled high blood pressure' can sometimes be as simple as making sure you're following the instructions for taking your medication. In fact, in about 40% of cases of 'uncontrolled high blood pressure', medications don't work properly because people don't take them properly . To get the most out of your medication, you need to take it every day, at the right dose, and for the right amount of time each day .

If you are having trouble taking your medication, be sure to talk to your doctor . You may be unable to take your medication properly because of side effects. If you are having side effects from one medication, your doctor may be able to give you a different medication. Or they may be able to switch you to a medication that you only need to take once a day. Never stop taking your medication without talking to your doctor.

If you are taking your medication correctly and still have 'uncontrolled high blood pressure', your doctor may add another medication. Some people may need to take four or five different types of blood pressure medications. The most common types of blood pressure medications are:

• Diuretics.
• Calcium channel blockers.
• ACE inhibitors/angiotensin receptor blockers (ACE inhibitors/ARBs).

Depending on your potassium level, your doctor may need to double your diuretic dose, add a fourth medication – an aldosterone antagonist such as spironolactone – to control your blood pressure. Or your doctor may choose a beta-blocker.

Side effects of treatment

Almost all medications can cause side effects. Side effects of high blood pressure medications include:

• Dizziness.
• Headache.
• Needing to urinate frequently.
• Constipation (difficulty going to the toilet).
• Dry cough.
• Tiredness.

How to reduce the risk of 'uncontrolled high blood pressure'?

To prevent your high blood pressure from becoming resistant to treatment, do the following:

• Follow your doctor's instructions exactly about taking your blood pressure medication.
• Maintain a healthy weight that suits you.
• Exercise for 150 minutes a week (spread it out over three to five days).
• Reduce the amount of salt you eat.
• Limit the amount of alcohol you drink.
• Sleep well every night.

What should I expect if I have 'uncontrolled high blood pressure'?

Many people with 'uncontrolled high blood pressure' can control their blood pressure with medication. In addition to prescribing medication, your doctor may want to try a few different approaches. For example, switching from one diuretic to a stronger one, or having you take your non-diuretic medication at night.

How do I take care of myself?

Living with high blood pressure is something you have to do all day, every day. Taking care of yourself includes:

• Taking your blood pressure medication at the right time and in the right dosage .
• Limiting the amount of salt and alcohol you eat and drink.
• Going to see the doctor on scheduled days (checkup appointments).
• Exercising regularly .
• Maintaining a healthy weight that suits you.
• Checking your blood pressure at home.

What are the best things to eat when you have 'uncontrolled high blood pressure'?

Salt increases your blood pressure , so it's best to avoid it. But you may not know which foods contain salt. You'd be surprised to learn that restaurant meals and processed foods contain a lot of salt . Avoiding and/or limiting these foods can help reduce the amount of salt you take in.

When should I see my doctor?

See your doctor if:

• If you are having trouble taking the medication your doctor has prescribed for you.
• If you take all your medications as prescribed, but your blood pressure levels are still high .

When should I go to the Emergency Treatment Unit (ETU) ?

A hypertensive crisis is a condition that requires immediate medical attention . In this case, your blood pressure suddenly becomes very high (180/120 millimeters of mercury - `180/120 mmHg`), and you experience symptoms such as:

• Severe headache.
• Chest pain (like a loud thud).
• Dizziness.
• Difficulty breathing.

What questions should I ask my doctor?

You can ask your doctor questions like these:

• Do I need to change my medications?
• What combination of blood pressure medication is best for me?
• How often should I check my blood pressure at home?
• How often should I come to see you for follow-up appointments?

It can be frustrating when you're taking multiple medications and not seeing any improvement. When you're on three different blood pressure medications, it can feel like a real struggle to get your blood pressure back to normal. Talking honestly with your doctor can help you find a solution to this problem. It's in your best interest to ask questions about anything you're not sure about.

Finally, remember this (Take-Home Message)

Resistant hypertension is a bit of a complicated condition, but that doesn't mean you can't control it.

• A proper diagnosis is very important. There may be another underlying cause for your high blood pressure.
• It is essential to take your medication correctly, on time, and in the prescribed dosage. If you have any questions, talk to your doctor.
• Lifestyle changes can have a big impact. Don't forget things like reducing salt intake, exercising, and maintaining a healthy weight.
• Maintain good communication with your doctor. Talk openly about your problems, how you're feeling, and the side effects of your medications.
• Never stop taking medication or change the dosage on your own.

Remember, you are not alone in this journey. Your doctor and healthcare team are here to help you. With a little patience, the right treatment, and lifestyle changes, you too can control this condition!