Beating high blood pressure that won’t budge 

Imagine you’ve put off changing the oil in your car and one day, when driving down the road, the engine suddenly heats up and everything goes haywire.  Now imagine if you pay little if any attention to your blood pressure when it’s out of control. You already know it tends to run high but you feel fine and figure a little high blood pressure is not that big of a deal.  Except for when you experience a major heart event such as a heart attack or even stroke.

No one wants to deliberately put themselves in danger of an avoidable health situation. Having uncontrolled or resistant high blood pressure puts you at risk of serious health consequences.  The first line of defense should be practicing healthy lifestyle habits – following a low sodium diet, regular exercise, not smoking, losing excess weight, and good stress management.

While lifestyle changes can be very helpful in combatting high blood pressure, for some people, they may not be enough if blood pressure doesn’t budge.  Sometimes certain factors out of your control may be affecting resistant blood pressure – African-American ethnicity, older age, and male gender.  When high blood pressure wont’ budge, this sets you up for health problems associated with hypertension such as stroke, heart attack, heart failure, kidney disease, and earlier death.

The American Heart Association considers high blood pressure or hypertension to be a high blood pressure reading of greater than 130/80 mm Hg (millimeters of mercury).  It’s considered resistant when one or both of the following factors are present:

·      Your blood pressure remains elevated despite the concurrent use of three or more classes of antihypertensive drugs, which typically include a calcium channel blocker, a diuretic, and an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), administered at the maximum dose a patient can tolerate.

·      Your blood pressure requires four or more antihypertensive drugs to achieve a target goal.

To confirm if you have resistant high blood pressure, your doctor will need to rule out other underlying causes, most of which are reversible, and include the following:

·      Not following your prescribed drug regimen – Up to 50% to 80% of people who need blood pressure-lowering medication do not take them as directed. One in four patients never fills their initial prescription for high blood pressure.  Simply by taking your medication regularly could quickly bring your blood pressure under control.

·      White coat hypertension– Some people become very anxious when seeing their doctor. This can cause an abnormal rise in blood pressure, resulting in what is known as white coat hypertension. To determine if this is true, a doctor may have you take your own blood pressure at home or wear a portable blood pressure monitor for 24 to 48 hours. If these readings are normal, then you likely don’t have resistant hypertension.

·      Errors in blood pressure measurements – If the person taking your blood pressure is not using the proper technique for measuring blood pressure, the result can be inaccurate. Ideally, when having your blood pressure taken, you should have been sitting quietly for at least 5 minutes with your legs uncrossed and your back, arms, and feet supported. Even a wrong cuff size, background noise, a full bladder or talking by you or the clinician, can affect blood pressure levels.

·      Inadequate therapy – This can happen if what your doctor communicated to you for your drug regimen has been misunderstood resulting in insufficient treatment for your high blood pressure. It’s best to have your doctor review your drug regimen to be sure you are taking the medication correctly and if there’s needs to be a change in medication or dosage.

·      Pain medication and other drugs - There are several pain medications that can raise blood pressure contributing to resistant hypertension. These include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naxopren (Aleve, and others), and celecoxib (Celebrex). Other drugs that can boost blood pressure include decongestants, diet pills, amphetamine-like stimulants, some antidepressants, glucocorticoids, and the immunosuppressive drug cyclosporine. If you take any of these medications and you are experiencing resistant high blood pressure, talk to your doctor about other options.

Other possible causes of resistant high blood pressure your doctor might consider:

·      Renal artery stenosis – a narrowing of the arteries that carry blood to the kidneys

·      Obstructive sleep apnea – a disorder characterized by pauses in breathing that result in temporary oxygen deprivation.

·      Chronic kidney disease – damage to the kidneys that causes their gradual loss of function

·      Primary aldosteronism – a disorder involving a hormone produced by the adrenal glands called aldosterone, which causes potassium loss and sodium retention.

Best ways for beating back resistant high blood pressure

When everything else has been done such as making lifestyle changes and reviewing of your medications by your doctor, and your blood pressure is still high, then it may be time to consider intensifying your treatment by doing one of more of the following:

·      Increase your dosages or change your dosing times

·      Switch your current diuretic with a long-acting thiazide diuretic if you are not already taking one

·      Add a fourth drug to your regimen, typically another type of diuretic called an aldosterone antagonist

If your blood pressure is still not responding after six months of making any of these changes, then your doctor might consider referring you to a specialist with expertise in managing resistant hypertension.