I see many patients with stubborn blood pressure (BP) every day but let me discuss two case studies so that we understand why it can sometimes get out of control. The other day a 60-year-old man complained of a sudden increase in BP readings recorded over two weeks. He had more than three medications to control it but it was difficult to keep it in the normal range of 130/80 mmHg. Another patient was much younger, possibly in his 30s, who complained of a similar condition. The first was heavy smoking and diabetes, the second was unhealthy overweight.
Both of them suffered from a condition where your blood pressure remains high despite taking medication to control or lower it. This is called resistant hypertension, which results in a higher risk of stroke, kidney disease and heart failure.
The 60-year-old had a history of high blood pressure, was a smoker and diabetic, making him already at risk for high blood pressure and heart disease. Given his uncontrolled readings, we admitted him and monitored him. However, despite the infusion, his blood pressure did not improve. Suspecting an underlying condition, often referred to as a secondary cause of resistant hypertension, we performed some additional tests. The good news is that once you identify the secondary cause, the condition is reversible.
We did a renal artery doppler (ultrasound) and discovered that he was suffering from renal artery stenosis, where one or more of the arteries that supply blood to your kidneys narrows and prevents oxygenated blood from reaching it. The kidneys respond by releasing hormones, which tell the body to drink more salt and water, increasing blood volume and raising blood pressure. Suspecting coronary artery disease, as happens in such cases, we performed angiography (which pictures the blood vessels) of both the kidneys and the heart and found blockages. Stenting was performed for both renal and coronary arteries. After these procedures restored blood flow, his blood pressure returned to normal.
Patients over 30 also had resistant hypertension due to a secondary trigger called sleep apnea, a disorder that disrupts breathing during sleep. When the amount of oxygen in the blood suddenly drops, the body constricts blood vessels and releases hormones, which raise blood pressure. The heart has to pump harder than normal. Treating the source of the problem also lowered her blood pressure levels.
In addition to the well-known co-morbidities, there are other triggers for BP, such as those mentioned above, production of adrenal hormones such as cortisol, hyperactive or underactive thyroid, cysts and tumors in the kidneys. Resistant hypertension can complicate the condition in up to 20 percent of patients, but people may be experiencing it for years without realizing it. That’s because it hardly manifests itself other than some chest tightness or some headaches.
That’s why it’s important to monitor your blood pressure regularly, when you have co-morbidities. You may need long-term medication or higher doses because your body needs it to control blood pressure at an optimal level.
(Dr. Tiku Director, Internal Medicine, Max Superspeciality Hospital, Delhi)
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