Often, I have patients coming in with complaints of stubborn blood pressure (BP) or hypertension despite taking prescribed medication to lower it. Some even complain that they need a higher dosage or perhaps a new drug combination. Their frustration level is understandable given that sustained BP puts them at a higher risk of stroke, kidney diseases and even heart failure. Stubborn or resistant hypertension is a condition where your blood pressure levels remain higher than 130/80 mmHg despite taking three blood pressure-lowering medicines and a diuretic.
Now what causes resistant hypertension? The primary reasons, which affect nearly 90 to 95 per cent of patients, are a poorly-managed lifestyle, genetics and their environment. Patients in this group usually have a high salt intake, eat unhealthy, are sedentary, overweight and indulgent about smoking and alcohol. Besides BP medicines have to be taken at the same time every day as recommended by your doctor to set up a patterned response. The good part is once these triggers are controlled, these patients can bring their BP levels down to safe levels. But about 5 to 10 per cent patients suffer from secondary hypertension, which are caused by kidney disease, hormonal imbalances due to excess production of certain hormones, diabetes, cardiac syndromes and sleep apnea.
PERSISTENT BP CAUSING HEADACHE? DON’T GO FOR THE PAINKILLER
Sustained high pressure can sometimes lead to sharp headaches and most patients go for ibuprofen to relieve themselves of pain. In fact, taking a headache pill during an episode of high BP may push it up further and increase the risk of heart attacks and strokes. Ibuprofen can also hinder common blood pressure medicines like ace inhibitors and beta blockers. Some people are allergic to ibuprofen, especially asthmatics.
NEW DRUGS, NEW HOPE
New research from CinCor Pharma, Brigham and Women’s Hospital, Harvard Medical School, and the Queen Mary University of London may offer hope to people living with uncontrolled high blood pressure or treatment-resistant hypertension. The study, published in “The New England Journal of Medicine,” shows how a new drug called Baxdrostat can significantly reduce blood pressure in people who have not responded to current treatments. It showed more than a 20-point reduction in systolic blood pressure. Interestingly, halving the dose to 1 mg also reduced blood pressure by over eight points when compared to the placebo. It stops the body from making aldosterone, which has been linked to resistant hypertension. Too much aldosterone increases the amount of salt and water re-absorbed from the kidney, increasing the volume of blood and blood pressure. It seems to be safe, and once cleared after final trials, could show the way. This drug also doesn’t interfere with the working of cortisol.
THE NEED FOR MONITORING YOUR BP
Most cases of resistant hypertension develop because about 60 to 70 per cent Indians are not aware that they have high BP and do not address it at the right time. And once high BP affects their kidneys or heart, they progress into secondary resistant hypertension. Checking BP is not part of a family health regimen until and unless you develop a condition. Once you reach a particular age, you should monitor your readings regularly. If you are above the age of 40, you should check it once every three months.
TAKE CARE OF LIFESTYLE MARKERS
Begin with your food, avoid junk food, cola and alcohol and reduce salt. The DASH (Dietary Approaches to Stop Hypertension) diet should prevent cardiac risks as it includes foods that are rich in potassium, calcium and magnesium. These nutrients help control blood pressure. The diet limits foods that are high in sodium, saturated fat and added sugars.
Studies have shown that the DASH diet can lower blood pressure in as little as two weeks. The diet can also lower low-density lipoprotein (LDL or “bad”) cholesterol levels in the blood. Basically, up your quotient of fruits and vegetables.
Take up any physical activity that you like for at least 30 minutes because exercise doesn’t come very easily to us as an everyday routine. Sleep well and if you have apnea, use a device to keep your airways free so that your body can rest and heal. Stay away from painkillers.