How to Beat Resistant Hypertension

Can’t get a handle on high blood pressure? You could have “resistant hypertension.” Here’s what will help get your numbers back to heart-healthy levels… Many people start each day by taking three pills for high blood pressure. Still, their hypertension defies treatment. The condition, called resistant hypertension, is dangerous, multiplying your risk for heart disease, stroke, kidney disease and other health issues, says Addison A. Taylor, M.D., Ph.D., chief of the division of hypertension and clinical pharmacology at Baylor College of Medicine in Houston. It’s common too. As many as one-third of the 43 million people diagnosed with high blood pressure have resistant hypertension, according to the American Heart Association (AHA). Because it’s on the rise, the AHA recently outlined specific guidelines on how to treat the condition. “Evaluating and treating resistant hypertension requires special consideration,” says David A. Calhoun, M.D., chair of the AHA’s guideline-writing committee. Defining Resistant Hypertension Blood pressure measures the force of blood flowing through the body. The top number, or systolic reading, is the pressure when your heart beats. The bottom, or diastolic, measures pressure between beats. With resistant hypertension, systolic readings surge to 145 or higher, and diastolic pressure hovers at 90 or higher. A resistant-hypertension patient’s blood pressure can’t be lowered, even when taking three drugs or more, explains Taylor. But there’s good news: Resistant hypertension can be treated effectively, says Jerome E. Granato, M.D., author of Living With Coronary Heart Disease: A Guide for Patients and Families (Johns Hopkins Press). But first, doctors look for its cause, which can vary by patient. Hypertension’s Causes Age, obesity and heavy alcohol or sodium intake can trigger resistant hypertension, according to the AHA report. But patients are their own worst enemies, too, Granato says. “Most resistant-hypertension cases result because patients don’t follow their treatment plan,” he says. Whether to avoid side effects or from forgetfulness, “some patients skip doses or stop taking their medication altogether." Others follow dosing precisely, but fail to exercise or cut salt out of their diet. Another problem: Patients’ white lies in the exam room. “They won’t tell their doctor they’ve skipped doses or aren’t exercising as recommended,” Granato says. “And those fibs make it hard [for a physician] to get resistant hypertension under control.” Medical Triggers But other factors also contribute, including common over-the-counter pain relievers, decongestants, stimulants and some herbal supplements (for example, yohimbe bark taken for sexual dysfunction). These block the effectiveness of blood pressure medications, Granato says. Medical conditions, such as adrenal tumors or sleep apnea, can also cause resistant hypertension. One of the most common triggers is primary aldosteronism, often caused by benign adrenal tumors (called adenomas) or an increase in normal adrenal gland cells. "In either case, primary aldosteronism elevates levels of the adrenal hormone aldosterone, leading to excessive water and salt retention, and hypertension," Granato says. It affects 10%-20% of patients diagnosed with hypertension and is so common that many physicians routinely screen hypertensive patients with a simple blood test. It’s also very treatable by using drugs to regulate adrenal function and blood pressure, Granato adds. Obstructive sleep apnea (OSA) is also prevalent among resistant-hypertension patients. “Those with OSA are often obese, and losing weight improves their symptoms and responsiveness to antihypertensive medications,” says Kameswari Maganti, M.D., director of cardiac rehabilitation at Chicago’s Northwestern Memorial Hospital. Using a continuous positive airway pressure (CPAP) device also lowers blood pressure among patients with OSA-related hypertension, according to 2010 Spanish study. CPAP helps regulate breathing via a face mask connected to a pump. The White-Coat Effect Some persistently high readings mimic resistant hypertension, but actually may be skewed by “white-coat syndrome,” which causes patients’ numbers to soar as soon as they walk into the exam room. “The fear of receiving bad news or overall anxiety over being in the doctor’s office causes blood pressure to [temporarily] rise higher than normal,” Granato says. Although several studies have recognized white-coat syndrome, a 2010 Israeli study published in the medical journal Hypertension focused on the effect that exam rooms have on blood pressure. Researchers found that women are more susceptible to higher-than-normal readings in a doctor’s office than men; their systolic readings increased an average 8.8%, and diastolic were an average of 8.3% higher than numbers recorded at home. Men’s numbers increased an average 6.1% systolic and 6.95% diastolic in doctors’ offices. If your pressure is always high at your doctor’s office, you have options: 1. Monitor blood pressure at home. “Talk to your doctor about ambulatory home monitoring for 24 hours,” which records readings during your normal daily routine, Taylor says. A device measures your blood pressure about every 20 minutes during the day and every 30-45 minutes at night, giving doctors a “clearer picture of blood pressure than one or two office readings,” Taylor says. You can also buy a monitor to record your blood pressure at home. Just remember to bring the device to checkups so your physician can compare office readings against yours at home. 2. Avoid coffee and cigarettes. To get more accurate numbers at home or doctor’s office, avoid coffee an hour preceding readings and don’t smoke for at least 30 minutes beforehand. Both can increase readings 10-15 points, Maganti says. 3. Change positions. Your body position influences the reading. “Posture and position of arms and legs can increase systolic numbers by 12.5%-14.2% and diastolic by 4.4%-7.6%,” Maganati says. If your blood pressure is high at doctor’s visits, change the way you sit. For the most accurate reading, sit upright in a chair with back support, not slouched over an exam room table, Maganti says. Hold arms at heart level, not hanging down, so your heart doesn’t have to pump hard to maintain adequate blood flow to your fingers. The blood pressure cuff should also be at the same level. 4. Take more than one reading. Ask for another reading once you’ve relaxed, or at the end of your doctor’s visit, after you’ve discussed questions or concerns with your doctor. Ways to Lower Blood Pressure The AHA has guidelines to help patients tackle resistant hypertension. Besides using drugs prescribed by your doctor, take these steps: Lose weight: Obese people often have more severe high blood pressure. Dropping pounds can not only treat resistant hypertension, but also reduce the number of drugs you take for it. Reduce salt: Cutting sodium intake from 1,200-1,500 mg a day can shave 5-10 systolic points and 2-6 diastolic points from blood-pressure levels. Limit alcohol: Cutting back on wine, beer and other alcoholic drinks can reduce systolic pressure by 7.2 points and diastolic by 6.6 points, while cutting the prevalence of hypertension by 30%, according to a 2009 study in the journal Hypertension. Time medications: Taking at least one of your hypertension medicines at bedtime leads to better blood pressure control, particularly during the night. “Taking prescribed blood pressure – controlling medicine, reducing alcohol and salt consumption, maintaining clear communication with your doctor, losing weight and getting exercise are the most effective ways to treat and prevent resistant hypertension,” Granato says.