Resistant hypertension (raised blood pressure) is slowly becoming a growing cause of concern in India, and globally, as untreated, high blood pressure (BP) increases the risk of heart attack, stroke and other serious health problems.
According to the World Health Organisation, hypertension causes an estimated 7.5 million deaths worldwide annually, which is roughly 12 percent of all total deaths.
In an interview with HT Lifestyle, Dr Praveen Chandra, chairman, interventional cardiology and structural heart, Medanta, talked about the growing risk of resistant hypertension, how it is becoming a growing cause of concern in India, renal denervation as a treatment method, warning signs and tests to know about, and more.
What is resistant hypertension, and how is it different from regular high blood pressure?
Dr Chandra explained that when blood pressure does not get controlled with the help of medications – especially when patients are taking 2, 3 medicines, or very high doses of medicine, and despite that, the blood pressure does not go down below our specified levels – then it is called resistant hypertension.
“So, for instance, when a person has high blood pressure, and despite medicines, the BP is above 130/80 or 140/90, indicating that the medicine is not working, and that means they have resistant hypertension,” Dr Chandra said.
As for the warning signs to look out for, the cardiologist warns that any patient who has high blood pressure must get a regular blood pressure checkup plan to know if they have resistant hypertension. “The problem is that most of the time, people take medicine but don’t check their blood pressure regularly, whether the medicine is effective or not. So, if the medicine is not effective, then we should take the next step. Otherwise, there is no benefit of treatment if your blood pressure is not controlled with the help of medicines alone,” Dr Chandra warned.
Hypertension, the silent killer: Tests and preventive measures
When asked if there are any tests or preventive measures that a high BP patient should know about, Dr Chandra highlighted that for resistant hypertension, patients should keep in mind these things:
- Take regular medicine
- Get regular blood pressure checkups done
- Take care of their diet, which should contain less salt, as an increased salt content in the diet is also another cause of high blood pressure
- Less alcohol consumption, because alcohol is one of the reasons for high blood pressure
- Stress, lack of sleep, and lack of physical activity can lead to high blood pressure.
How strongly is resistant hypertension related to stroke, heart attack, kidney failure, or other heart complications?
Dr Chandra stressed that there is a very high risk of having a kidney problem, a stroke, and also heart failure because of high blood pressure, and that is why it is known as a silent killer. He warns, “Often your BP will be high and you won’t know about it and it will just silently keep harming your kidney, your brain, and your heart.”
But does it always lead to heart attack and kidney failure, or can it be prevented if you take medications? According to Dr Chandra, the answer is no. Moreover, if you take medications and keep your BP under control, below the level of 130/80, then these complications can be reduced drastically.
Why is there a high prevalence rate in India?
According to Dr Chandra, resistant hypertension now affects the entire country, with almost every 4th person being detected with high blood pressure (28 percent of Delhi residents and 23 percent in Haryana). “That is why it is important that every person should have a blood pressure checkup done once a year at least,” he stressed.
But why a rise in numbers? The cardiologist points out that it is a lifestyle-related issue, caused by: “stress, lack of sleep, increased alcohol content, and increased salt content.
So, can controlling diet, exercise and stress help in resistant hypertension management? “Diet, exercise and stress have a very important role to play in resistant hypertension management. For high blood pressure treatment, the first step is diet control, regular exercise, or lifestyle-related changes, and then, only if the BP is still high, we give medicines,” Dr Chandra answers.
Hypertension and the younger population
When asked how important early screening is, and the key things young high BP patients should know about, Dr Chandra stressed that early screening, regular checkup, and control of high blood pressure are the three most important things.
He added, “The key thing is that one should get their blood pressure checkup done once in a year and for those with high blood pressure, they should get it checked every month, and then keep taking their medications regularly, do not overindulge in high salt food, alcohol, and sleep well, reduce stress, and maintain good lifestyle, and that should be the best way to treat high blood pressure.”
Renal denervation: An effective treatment?
Explaining what renal denervation is and how it treats high blood pressure, Dr Chandra said, “For resistant hypertension, up till now, apart from medicines, there was no treatment. Now, this is a new treatment which we have started in those patients who cannot control their blood pressure despite taking all the high doses of medicine, and that is why it is very important to discuss this treatment option with them, and it is a one-time treatment.”
As for its effectiveness, the cardiologist highlights: “The effectiveness of this is that 50 percent of the patients after getting renal denervation will get their blood pressure under control, about 30 percent will actually half the dose of the drug, and almost 20 percent may not need any drug after this treatment.”
As for its availability in India, Dr Chandra pointed out, “We have just started this treatment. In Medanta, it is the largest center which has done the maximum number of people for this treatment.”