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Hypertension and Stroke Special Report

Controlling Difficult-to-Control Hypertension

If you're being treated for hypertension, your physician wants your blood pressure to reach certain goals. For most individuals, that goal is less than 140/90 mm Hg. For people with diabetes or kidney disease, the goal is even lower -- less than 130/80 mm Hg. Some people attain these goals while taking one or two blood pressure medications. Others need three. But when three drugs don't get your blood pressure to the target level, you have difficult-to-control hypertension, also called resistant hypertension. Here’s what you should know.

Up to 30% of people treated for hypertension have the resistant form of hypertension. The American Heart Association (AHA) recommends these guidelines on managing resistant hypertension.

Secondary causes. In some people, resistant hypertension can be traced to a specific, treatable condition. One example is obstructive sleep apnea, a breathing disorder that causes loud snoring, frequent nighttime awakening, and daytime sleepiness. Another secondary cause is primary aldosteronism (overproduction of aldosterone, a blood pressure-boosting hormone). Kidney diseases, such as renal artery stenosis and renal parenchymal disease, also can lead to resistant hypertension.

If you have resistant hypertension, your doctor will probably screen you for these conditions. Managing them through medication, lifestyle changes, and other measures may effectively lower your blood pressure.

Medication as the culprit. A rise in blood pressure can be a side effect of some drugs and supplements. Common culprits are nonsteroidal anti-inflammatory drugs, or NSAIDs, pain medications that include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and celecoxib (Celebrex). Decongestants, diet pills, and any medication or herbal supplement containing a stimulant can boost your blood pressure as well.

Lifestyle changes. Just as with high blood pressure in general, a healthy lifestyle is key to managing resistant hypertension. Obesity is one of the strongest risk factors for difficult-to-control blood pressure, so if you are significantly overweight, losing some of those extra pounds can make a major difference in your blood pressure.

You should also watch your alcohol consumption (no more than two drinks a day for men, one drink for women) and salt intake (less than 1,500 mg per day). In addition, work on eating more fruits, vegetables, and whole grains and getting at least two servings of low-fat dairy products each day. These foods form the basis of the Dietary Approaches to Stop Hypertension (DASH) diet.

Regular exercise is important, too, and the AHA guidelines call for people with resistant hypertension to get 30 minutes of moderate exercise, such as walking, on five to seven days of the week.

Treatment optimization. By definition, resistant hypertension has thwarted triple-drug therapy. But that does not mean medication cannot work for you. If you're not currently taking a diuretic for your blood pressure, adding one may help. Studies show that a large percentage of people diagnosed with resistant hypertension are either not on a diuretic or not on a high-enough dose.

The addition of drugs called aldosterone blockers can help some people. These drugs, such as spironolactone (Aldactone), treat primary aldosteronism, a common cause of resistant hypertension. And recent studies suggest that spironolactone may also lower blood pressure in people who have resistant hypertension not caused by primary aldosteronism.

Besides adding different medications, your doctor may also ask you to experiment with the timing of your doses. Studies show that people who take at least one of their blood pressure drugs at bedtime have better blood pressure control.

Don't Give Up. Lowering your blood pressure is one of the most important things you can do to reduce your risk of heart attack, stroke, kidney disease, and vision loss. Having resistant hypertension makes it more difficult; however, do not give up. Work with your doctor to develop a treatment plan, and then follow it.

Posted in Hypertension and Stroke on September 22, 2009


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