Therapy-Resistant or Difficult-to-Control Hypertension
When is Hypertension Therapy-Resistant?
Hypertension is considered therapy-resistant when the target value agreed upon with the doctor cannot be achieved despite treatment with three different antihypertensive medications.
What Causes Can This Have?
About 30% of cases classified as therapy-resistant hypertension are secondary hypertension. In these cases, hypertension is caused by another disease or by medications. It is important to find the cause. If another disease is present, it must be treated first. Other medications taken must also be reviewed and possibly adjusted.
Additionally, the previous type or combination of antihypertensive medications and their dosing schedule may be the reason for insufficient blood pressure reduction. Depending on any other diseases the patient may have, both the antihypertensive medications from the appropriate substance classes must be chosen, and the dosing plan must be created considering the duration of action (half-life) of the medications.
Pseudoresistance
However, there are also factors that make blood pressure appear difficult to control, where there is no true therapy resistance. This is referred to as pseudoresistance.
White Coat Hypertension
For example, blood pressure values may be higher during a doctor's visit than in normal daily life, which is referred to as white coat hypertension. A 24-hour blood pressure measurement or regular self-measurements of blood pressure at home can provide more clarity. See also „White Coat Hypertension“.
Measurement Errors
However, home blood pressure measurements can also be a source of pseudoresistance if the values are falsely elevated due to measurement errors. See also „Errors in Blood Pressure Measurement“.
Lack of Treatment Adherence
Another common reason for a perceived therapy resistance of hypertension is a lack of adherence (see also “Adherence and Compliance - Treatment Adherence“) of the affected individual. If the lifestyle changes discussed with the doctor, which are of utmost importance, are not followed, or if the medications prescribed for high blood pressure are not taken or not taken according to the established medication plan, a lack of or absent blood pressure reduction is not surprising. This was also shown in a Canadian study where participants suffering from supposedly therapy-resistant hypertension had to take their medications under supervision. This led to a decrease in values for all participants. About one-third even reached the normal range. Half of the participants had already experienced a cardiovascular event attributed to hypertension. Unfortunately, even this was not sufficient motivation to take the medications regularly and as prescribed.
What to Do About Difficult-to-Control Hypertension?
Fundamentally, even with difficult-to-control hypertension, reviewing and possibly optimizing lifestyle is essential. This is good news, as everyone can take action here and perhaps adjust their diet, exercise, stress reduction, or also reduce alcohol and nicotine consumption. It should go without saying that medications are taken regularly as prescribed by the doctor.
If secondary hypertension is present, the underlying disease must be treated to gain control over blood pressure.
If blood pressure remains unaffected by all efforts to lower it, even with the best adherence, there are still some pharmacological or even surgical procedures available, such as renal denervation (see also "Hypertension and Kidneys") or the implantation of a special pacemaker (see also "Pacemaker for Hypertensives"), to move it towards normal values. What is appropriate for the affected individual must, however, be clarified individually with the treating physician.
Sources:
- https://aerztezeitung.at/2017/oaz-artikel/medizin/therapieresistente-hypertonie-pseudoresistenz-priv-doz-michael-rudnicki-univ-prof-bruno-watschinger/
- https://www.pharmazeutische-zeitung.de/die-resistenz-die-keine-ist/
- https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2735985
- https://www.patienten-information.de/patientenleitlinien/bluthochdruck
- https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2815018
- https://www.pharmazeutische-zeitung.de/spironolacton-am-wirksamsten-145440/
- https://www.patienten-information.de/patientenblaetter/bluthochdruck-nichtansprechen
- https://www.hochdruckliga.de/pressemitteilung/neue-optionen-bei-therapieresistenz-zertifizierung-renale-denervierungszentren
- https://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-1031-0612.pdf
- https://www.medical-tribune.de/medizin-und-forschung/artikel/die-therapieresistente-hypertonie-ist-manchmal-gar-keine
- https://www.rosenfluh.ch/media/arsmedici-dossier/2010/04-05/Therapieresistente_arterielle_Hypertonie.pdf
- https://idw-online.de/de/news681153
By Sabine Croci.
This article is medically reviewed. Last updated (07/2024).
Information on the website and within the app cannot replace a consultation with a doctor, but can certainly complement it.
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