Is your blood pressure out of control? Understanding resistant hypertension and what can help

Unlike standard hypertension, which usually responds to medications and lifestyle modifications, in resistant hypertension, the BP remains elevated despite adherence to recommended treatment. Photograph used for representational purposes only
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High blood pressure is a common concern in India. But what happens when standard treatments don’t work? This is the reality of resistant hypertension, a condition requiring specialised care. According to the World Health Organisation, approximately only 1 in 5 adults (21%) with hypertension have it under control.

A secondary analysis of the National Family Health Survey-5 data found that almost 36.8% of Indian women and 49.5% of men with hypertension in India don’t have the condition under control despite being on medication. This isn’t just high blood pressure—it’s a resistant form that remains uncontrolled despite standard treatment and requires a more specialized approach.

What is resistant hypertension?

Resistant hypertension is defined as blood pressure that remains above 140/90 mmHg despite adherence to a regimen of three or more antihypertensive medications, including a diuretic, all at optimal doses. Unlike standard hypertension, which usually responds to medications and lifestyle modifications, in resistant hypertension, the BP remains elevated despite adherence to recommended treatment. Resistant hypertension may affect more people than you think. Despite the growing burden of this condition however, hypertensive disorders are still not looked at with the urgency they deserve. Many people view high blood pressure as a manageable part of life, unlike conditions such as cancer, which evoke far greater concern. This lack of awareness means that many patients continue to live with uncontrolled hypertension for years, risking severe complications such as heart failure, stroke, and kidney damage. The emotional toll can also be significant, with patients feeling frustrated, anxious, or disheartened by their inability to bring their blood pressure under control.

For those dealing with resistant hypertension, a diagnosis involves ruling out factors that can mimic resistance, such as inaccurate blood pressure readings or interactions with other medications. Once confirmed, identifying the underlying cause is key. Resistant hypertension is driven by one or more underlying causes. According to the American Heart Association, these can include hormonal imbalances that affect blood pressure, plaque buildup in the arteries supplying the kidneys, and sleep-related disorders such as sleep apnea. Ambulatory BP monitoring, hormonal testing, imaging of the kidneys, sleep studies, and a detailed review of the patient’s medication and medical history can all help uncover the root cause of the problem.

Treatment options

In recent years, treatment options for resistant hypertension have expanded beyond medication alone. One of the most promising advances is a minimally invasive procedure known as renal denervation (RDN). This technique uses radiofrequency energy to disrupt the overactive sympathetic nerves around the renal arteries. By targeting these nerves, RDN helps reduce and regulate the sympathetic drive that keeps blood pressure elevated in many patients with resistant forms of the condition.

While the idea of undergoing a procedure for hypertension may initially seem excessive, especially given how the condition is perceived, this mindset is beginning to shift. RDN is gaining recognition for its potential to provide sustained blood pressure control and reduce the long-term risk of organ damage. For patients who have exhausted conventional treatment options, RDN offers renewed hope, particularly when combined with ongoing lifestyle support and medical care. According to a study in TheLancet study, it complements both medication and lifestyle changes, but unlike medications, RDN maintains blood pressure reductions consistently over a 24-hour period.

Need for greater awareness

Resistant hypertension is not just a more stubborn version of high blood pressure—it is a distinct medical condition that requires deeper investigation, targeted treatment, and a shift in how both patients and clinicians approach it. With greater awareness, timely diagnosis, and innovative therapies like RDN, it is possible to bring even the most unrelenting cases of high blood pressure back under control—and protect long-term health in the process.

(Dr. Y. Vijayachandra Reddy is a senior consultant & interventional cardiologist at Apollo Main Hospitals, Chennai. The views expressed here are the doctor’s own and intended for general information and educational purposes only. They do not constitute medical advice. Email: yvcheart@yahoo.co.in)