Health Science Reviews

by Mia Briner

Levels 1 and 2 of hypertension are easy: do some yoga, eat some veggies, and boom, blood pressure remains healthy.  By level 10, no amount of Sea Point promenade walks is going to stop your heart from pretending it’s in a Fast & Furious movie. So welcome to the final and hardest level of hypertension: resistant hypertension.

Picture this: you are about to finish the video game you have been playing for hours, the final boss’s health has just hit zero, you think you won, it’s time to start celebrating, but oh no, the boss is getting back up. What is happening? That’s kind of how resistant hypertension works. Even if you are on three or more antihypertensive medications (including a diuretic), your blood pressure refuses to stay below 140/90 mmHg. Oh, and even if you control your blood pressure with the help of a fourth drug, you are still considered one of the elites with resistant hypertension.

So, how unique are you? Unfortunately, not very, 9-18% of all hypertension patients are on this level with you. When you put that into perspective, that’s a lot of people taking more than 3 pills a day, all for one supervillain disease. To make matters worse, some people think they have resistant hypertension, but it’s just pseudo-resistance, which can be from faulty blood pressure readings, stressful doctor visits (white-coat effect), or not adhering to medications.

So why do some people get this far, and others don’t? Many factors could cause resistant hypertension, like skipping medications (I don’t care what TikTok told you, those online herbal teas will not cure you). Other reasons could be eating too much sodium, an overactive sympathetic nervous system, or, surprisingly, sleep apnoea. Nearly 50-60% of people with obstructive sleep apnoea have hypertension. Along with sleep apnoea, be on the lookout for other conditions that go hand in hand with hypertension, like diabetes and chronic kidney disease.

Treating resistant hypertension is a full 9-5 job. Most important, lifestyle changes, less salty snacks, more Zumba classes, and less cigarettes and alcohol. Other powerups to manage resistant hypertension include medications like ACE inhibitors, diuretics, beta-blockers, and calcium channel blockers. If those power-ups don’t work, there are crazy sci-fi gadgets to help, like Renal Denervation, where your kidneys are stimulated by radio waves in hopes of calming down your arteries.

The final boss always feels impossible, but if you don’t give up, there is a way to get around him. Keep eating healthy, exercising, and taking your meds to ensure you stay here long enough to see the aliens finally invade Earth. If you’re nervous, get regular doctor check-ups to be on the lookout (and don’t worry if the doctor gets confused, just give them this blog, I’ll clear it up for them).

Reference:

Chhabra P, Dutta RR, Sahu P, Joshi A. Beyond Conventional Control: Insights Into Drug-Resistant Hypertension. Cureus. 2023 Aug 17;