Understanding Resistant Hypertension
Resistant hypertension can complicate body conditions in about 20% of patients, yet many might experience it for years without awareness. This article explores two case studies, showcasing the real-life challenges faced by patients with stubborn high blood pressure.
Case Stud ies
Recently, a 60-year-old man reported a sudden spike in his blood pressure readings over a two-week period. Despite being on more than three medications, he struggled to maintain his blood pressure at a normal range of 130/80 mmHg. Another patient, a man in his 30s, presented with similar difficulties; he was noted to be overweight.
Both patients suffered from a condition known as resistant hypertension, which elevates the risks of stroke, kidney disease, and heart failure. The older gentleman had a longstanding history of hypertension, diabetes, and smoking, predisposing him to severe health issues.
Identifying Underlying Causes
Upon hospital admission, we monitored the older gentleman, but despite intravenous treatment, his blood pressure remained high. Suspecting a secondary cause for his resistant hypertension, we performed further tests. Fortunately, secondary causes can often be reversible.
A renal artery doppler ultrasound revealed renal artery stenosis, a condition where arteries supplying blood to the kidneys are narrowed, restricting vital blood flow. Moreover, angiography indicated blockages, leading us to perform stenting to restore blood flow, which resulted in normal blood pressure levels.
Sleep Apnea as a Trigger
Conversely, the younger patient’s resistant hypertension was triggered by sleep apnea, a disorder characterized by disrupted breathing during sleep. As blood oxygen levels drop, the body compensates by constricting blood vessels and releasing hormones that elevate blood pressure.
Treating the root cause — in both cases — led to stabilized blood pressure readings.
The Importance of Regular Monitoring
These scenarios highlight critical points: beyond known health conditions, various triggers exist for hypertension, including hormonal imbalances and certain kidney conditions. Resistant hypertension can be elusive, often presenting only mild symptoms like chest tightness or headaches.
It’s crucial for individuals with pre-existing conditions to monitor blood pressure regularly. Adapting medication doses according to body needs is essential in maintaining optimal blood pressure control.
(Dr. Tickoo is Director, Internal Medicine, Max Superspeciality Hospital, Delhi)
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