Pathology

Characteristics of Resistant Hypertension



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Resistant hypertension is high blood pressure that does not respond to treatment.  Specifically, this condition is defined as blood pressure that remains elevated above a specified treatment goal despite administration of a drug regimen consisting of three different drugs. Because some cases of high blood pressure may require a combination of multiple drugs before the blood pressure remains at a constant, lower level, high blood pressure cannot be named “resistant hypertension” until this specific drug combination has failed.

In order for resistant hypertension to be diagnosed, several conditions must be met.  According to the standard guidelines, the blood pressure method of measurement must be standard, the size of the blood pressure cuff should be double checked for accuracy and proper functioning, and the blood pressure readings must be recorded on two separate days.  Resistant hypertension can only be diagnosed if these conditions have been met.

Resistant hypertension can be caused by a number of environmental and genetic factors.  In general, however, the main reason that resistant hypertension gets diagnosed is that the patient has become noncompliant with treatment.  While this may mean that he or she has stopped taking his or her medication and/or is no longer is following the diet and exercise regimen prescribed by his or her doctor. Patient noncompliance is not always the patient’s fault.  If the prescribed medication caused a bad reaction or cannot be taken with other drugs, patient noncompliance is the reason for the diagnosis, but the diagnosis is certainly not seen as something the patient could have changed or fixed on their own.  Resistant hypertension can also be diagnosed, however, as a form of secondary hypertension, usually a result of overactive adrenal glands.  Finally, excessive amounts of fluid retention, usually caused by kidney failure can lead to a diagnosis of resistant hypertension.

Because resistant hypertension is usually the result of an underlying issue, the treatment for this condition should focus on correcting this issue. In a case where the resistant hypertension is caused only by patient noncompliance, a doctor should first determine the cause of the noncompliance.  Then, the doctor and patient should work together on a plan to bring the patient back into compliance with the drug, diet, and exercise plan.  In a situation where the body fluid balance is abnormal, having the patient undergo dialysis may be necessary. If a hormone imbalance is the cause of the resistant hypertension, treatment efforts should be focused on correcting the patient’s hormone profile through drug therapies.

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