Hard-to-manage high blood pressure often manageable

(Times Dispatch) —

Q: How common is high blood pressure that does not respond to medication?

A: High blood pressure is also called hypertension. Normal blood pressure is less than 120/80. Pre-hypertension is when the top number is 120 to 139 and the bottom number is 80 to 89.

High blood pressure is blood pressure 140/90 or higher. Hypertension increases risk for stroke, congestive heart failure, kidney disease and heart disease. Blood pressure generally rises with age, and close to a third of Americans over age 18 have high blood pressure.

Blood pressure that stays above goal despite aggressive treatment is called resistant hypertension. Aggressive treatment, in this case, means the patient is on optimal doses of three anti-hypertensive drugs at the same time, with one of the drugs being a diuretic or water pill.

“The majority of difficult-to-treat hypertension in the right hands is probably manageable, but there aren’t enough good hypertension specialists in the country to handle all the difficult-to-treat hypertension,” said Dr. Domenic A. Sica, a professor at Virginia Commonwealth University and one of the authors of a recently published research paper on an implanted device to treat resistant hypertension.

A 2008 American Heart Association statement on resistant hypertension examined factors that may lead to incorrect diagnoses of resistant hypertension. Sica was one of the authors of the AHA statement.

Those factors include improper technique for taking blood pressure. Too small a blood pressure cuff, or taking the measurement before the patient has sat quietly for a period, can result in falsely high readings. Another factor is the phenomenon of “white coat” hypertension, in which a patient’s blood pressure rises, because of nervousness or anxiety, in the doctor’s office but is normal or lower in most other situations. In addition, patients may not be taking their medication as prescribed.

Nonetheless, prevalence of resistant hypertension, which is associated with older age and obesity, is expected to increase as the population gets fatter and older.

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