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SOME individuals with hypertension (about one in eight) are doing all the right things yet still can’t manage to control their blood pressure — they have what’s known as resistant hypertension:

blood pressure that lingers above a preset target despite the use of three medications, or control achieved only with the use of four or more medications, says the September 2011 issue of the Harvard Heart Letter.

Statistics from the National Health and Nutrition Examination Survey show that heart disease is so much more common in individuals with resistant hypertension than it is among those with controlled blood pressure.

Studies show that fewer than half of the 60 million Americans who know they have high blood pressure (also known as hypertension) have it under control.

While some of them aren’t taking medicines to lower their blood pressure or haven’t made the necessary lifestyle choices, some of their doctors aren’t prescribing the right medicines at the right doses, adds the health letter.

Nevertheless, some of these individuals are doing all the right things but still can’t manage to control their blood pressure — they have what is known as resistant hypertension.

Although many things contribute to resistant hypertension, the health letter offers two factors that are often overlooked, as suggested by new studies:

• White coat effect — The blood pressure of some individuals spikes into the uncontrolled range in the doctor’s office but is in the target range at home — this is called the white coat effect.

Results of a large Spanish study published in the 2011 issue of Hypertension showed that 12% of men and women with high blood pressure had resistant hypertension based on blood pressure measurements in the doctor’s office but recordings showed that one-third of them actually had their blood pressure under control when those individuals wore portable blood pressure meters for 24 hours.

• Sleep apnea — This nighttime breathing pattern is common among individuals with resistant hypertension — the more severe the sleep apnea the higher the blood pressure.

According to a University of Alabama study (published online, June 9, 2011, Journal of Human Hypertension), researchers have linked high levels of aldosterone, a hormone made by the adrenal glands, with both sleep apnea and resistant hypertension.

They suggest that adding an aldosterone blocker such as spironolactone (generic, Aldactone) or eplerenone (generic, Inspra) to the medication regimen may improve both sleep apnea and resistant hypertension.

The control of blood pressure is important because studies have shown that the rates of various cardiovascular problems are lower in individuals with controlled hypertension than in those with resistant hypertension:

Controlled/hypertension/Resistant hypertension

a. Coronary artery disease: 9%/22%

b. Heart failure: 4%/10%

c. Diabetes: 20%/35%

d. Stroke: 4%/10%

Some self-help measures that can help control resistant hypertension include:

1) Know your true blood pressure — Make sure you know your true or average blood pressure by checking it a few times a day at home, or asking your doctor about 24-hour blood pressure monitoring.

2) Optimize your medication — a) Some individuals respond to certain drug types than to others;

b) The time of day you take your medications may make a difference — some can get by with once a day medication, while others need to take shorter-acting pills two or three times a day.

Nearly everyone with resistant hypertension should be taking a thiazide diuretic such as chlorthalidone or hydrochlorothiazide.

Medications that can be added to the diuretic include a beta blocker, calcium-channel blocker, ACE inhibitor, angiotensin-receptor blocker, aldosterone antagonist, or rennin blocker.

3) Beware other pills and potions — Some drugs and supplements can boost blood pressure, including painkillers such as ibuprofen, naproxen and celecoxib (Celebrex); diet pills; cocaine, amphetamines and other stimulants, natural licorice; ephedra (ma huang); and yohimbine.

4) Get a checkup — The American Heart Association recommends that anyone with resistant hypertension be checked for three conditions that contribute to it: overactive adrenal glands, silent kidney disease and sleep apnea.

5) Shake the salt habit — Individuals with resistant hypertension seem to be especially sensitive to the pressure-boosting effect of sodium — try to keep your daily intake of sodium under 1,500 milligrams (about two-thirds of a teaspoon of salt).

Be aware of how much sodium you take in, especially from processed or prepared foods.

6) Stick with the standards — All of the elements of a healthy lifestyle can help lower blood pressure, which include:

a) exercise;

b) weight control;

c) eating more fruits and vegetables;

d) not smoking;

e) alcohol in moderation, if at all; and

f) meditation, relaxation, or other stress relieving activities, concludes the health letter.

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