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.
