Physicians are suggesting that patients suffering from resistant hypertension must reduce their weight and also cut back salt and alcohol intake.
New guidelines issued by the American Heart Association and co-authored by UAB physicians recommends that resistant hypertension, where blood pressure remains above goal despite taking three antihypertensive medications or high blood pressure that is controlled but requires four or more medications to do so, may benefit from specialized diagnostic and therapeutic treatment by health care providers.
The team led by Dr David A. Calhoun, professor of medicine in the UAB Division of Cardiovascular Disease said that effectively treating resistant hypertension requires patients to modify lifestyle factors that contribute to treatment resistance, including using less salt, losing weight and drinking less alcohol.
It also requires physicians to better diagnose and treat secondary causes of high blood pressure and more effectively use multiple-drug treatments.
"Older age and obesity are two of the strongest risk factors associated with resistant hypertension and unfortunately, with an aging and increasing heavy population, we can anticipate resistant hypertension becoming more and more common," said Calhoun.
"And people need to recognize the importance of blood pressure control. Persons with resistant hypertension are at increased risk for cardiovascular diseases, including heart attacks and strokes," he added.
The physicians also said that effective use of diuretics is essential for treatment of resistant hypertension.
They recommended a long-acting diuretic be part of the treatment regimen of all patients with resistant hypertension in order reduce fluid retention and thereby blood pressure.
He added that some patients may also benefit from adding mineralocorticoid receptor antagonists (MRAs) to their treatment regimens.
MRAs have traditionally been used to treat a condition called primary aldosteronism, which is found in about 20 percent of patients with resistant hypertension. However, recent clinical studies indicate that MRAs may be useful in treating resistant hypertension even in the absence of demonstrable aldosterone excess.
"Hypertension specialists are using them more commonly, but they are probably not being routinely used by other physicians.
"Prescription of MRAs does require biochemical monitoring, particularly measurement of serum potassium levels, which does limit there use," he added.
Calhoun said it is important to understand the difference uncontrolled high blood pressure and resistant hypertension as they are not same.
"High blood pressure readings can be caused by poor medication adherence, which is not the same as resistant hypertension," he said.
"Confirming treatment resistance is the first step in evaluating difficult-to-treat high blood pressure," he added.