In a nation where nearly one-third of adults are silently suffering from the burden of high blood pressure, stressing the urgent necessity for routine blood pressure screenings is indispensable. It saves lives. Hypertension is frequently unnoticed, but it is never harmless. Early detection is crucial, but so are the subsequent steps: sustained treatment, interpretation, and diagnosis.

What occurs if blood pressure remains elevated after all the appropriate actions are taken? In response to a question about resistant hypertension during an HT Lifestyle interview, Dr. Viveka Kumar, Chief of Cath Labs (Pan Max) - Cardiac Sciences in Delhi, stated, "It's called resistant hypertension. This advanced form of high blood pressure persists despite optimal doses of medication and consistent lifestyle changes."

He stated, "For many patients, especially those who are already diagnosed and receiving treatment, the process of measuring their blood pressure doesn't end there; instead, it starts with something as straightforward as that. Life-saving interventions may result from it." It's a warning sign for something more complicated when we consistently observe elevated levels in spite of medication and lifestyle modifications.

“Resistant hypertension is not a failure of effort—it’s often a sign that we need to dig deeper,” Dr. Viveka Kumar said. Recognizing this allows us to not only identify hypertension but also treat it precisely. It might point to secondary causes such as hormonal imbalances or renal artery stenosis, or it could point to problems with how we measure and interpret blood pressure.

1. Resistant hypertension is frequently overlooked or misinterpreted

"Most people assume that when blood pressure stays high despite medication, it's just stress or wrong medication dose but resistant hypertension is a specific clinical condition," Dr. Viveka Kumar stated. This indicates that a person's blood pressure stays above the target level even though they are taking three or more drugs, such as a diuretic. However, a formal evaluation for it is never conducted for many patients.

The danger? Dr. Viveka Kumar stated, "Repeated dose adjustments without ever finding the actual cause." It impacts around 10% of those with hypertension, and it is frequently overlooked or ascribed to insufficient treatment or adherence. In reality, it may indicate a more complicated or secondary issue that needs specialized assessment and care. A high blood pressure reading indicates the need for further investigation. It's the beginning of gaining control over your health.

2. It's more frequent than you realize for people to skip their medications, and this behavior is frequently mistaken for "resistance."

According to a study published in the Mayo Clinic Proceedings Journal, 50 to 80 percent of hypertensive patients fail to adhere to their prescription medications. Non-adherence is a major cause of uncontrolled blood pressure and can resemble resistant hypertension, whether it is caused by confusion, expense, or adverse effects.

Dr. Viveka Kumar recommended that it is important to verify before increasing therapy:

• Are the drugs being used regularly?
• Are the doses being modified correctly?
• Do patients receive appropriate information and follow-up support?

It's time to seize control.

3. Other things matter in addition to the medicine

Although many people believe that resistant hypertension just entails not following prescribed medication, the truth is more complicated. "Sometimes, it’s not just about the treatment, but about what’s happening inside the body," explained Dr. Viveka Kumar. Despite treatment, an excessively active sympathetic nervous system can narrow blood vessels and raise blood pressure, keeping the body in a perpetual state of "high alert."

He went on to say, "Other factors—like sleep apnea, hormonal imbalances (such as problems with aldosterone or thyroid function), or kidney diseases—can also make it difficult to manage high blood pressure." Even some drugs, such as antidepressants, steroids, and pain relievers, might have an effect on blood pressure. Lifestyle factors such excessive salt, alcohol, weight gain, or chronic stress can exacerbate the problem.

4. Beyond medications, there are newer, interventional options

Interventional therapies are becoming feasible alternatives when drugs are insufficient and secondary causes have been excluded. "One of the most promising is Renal Denervation (RDN), a minimally invasive procedure that targets the overactive nerves around the kidneys," Dr. Viveka Kumar explained. RDN provides hope for patients whose hypertension is resistant to medical treatment by lowering blood pressure through nerve deactivation. The treatment is receiving interest in India's advanced cardiac facilities, especially for those who still experience high blood pressure despite extensive attempts with drugs and lifestyle modifications.

5. The hypertension epidemic in India makes it more difficult to identify resistant hypertension and more harmful to overlook

India is experiencing an epidemic of high blood pressure. Only 12% of the over 220 million adults who have high blood pressure have it under control. These concerning statistics, from the NFHS-5 and national health programs, highlight a disturbing disparity in the continuous treatment of the condition as well as in knowledge. In this situation, resistant hypertension is frequently undetected.

Dr. Viveka Kumar stated, "Many patients are not screened thoroughly enough, secondary causes are overlooked, and interventional treatments remain limited to a few advanced centers in urban areas." Don't just measure; take action and take control! Resistant hypertension is more prevalent in India than we are aware of, and if neglected, it might result in severe lasting effects.

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