Clinical Evaluation of Patients of Resistant Hypertension

Dr Prabhakar Shivshankar Jirvankar; Dr Sunil Patil; Dr Aishwarya Jirwankar

Volume : VI, Issue : V, May - 2017

Clinical Evaluation of Patients of Resistant Hypertension

Dr Prabhakar Shivshankar Jirvankar, Dr Sunil Patil, Dr Aishwarya Jirwankar

Abstract :

Resistant hypertension is a common clinical problem faced by both primary care clinicians and specialists. The joint National Committee 7 defines resistant Hypertension as failure to achieve goal B.P. (< 140/90 mm Hg for the overall population & < 130/80 mm Hg for those with diabetes mellitus or chronic kidney disease) when a patient adheres to maximum tolerated doses of 3 or more antihypertensive drugs including a diuretic¹. Causes of true resistant hypertension include Chronic Kidney Disease (CKD), Obesity, obstructive sleep apnea, volume over load, drug induced hypertension NSAID use, excessive alcohol intake².

A cross sectional observational study consisting of 40 patients of resistant hypertension, was undertaken to study clinical profile and to evaluate various causes of resistant hypertension. Most common associated co-morbid condition was CKD (52.5%), followed by IHD (15%). Less common conditions were Renal artery stenosis (12.5%), CVA (12.5%), SLE (5%), Coarctation of aorta (2.5%) , COPD (2.5%) and lgA Nephropathy & Nephritic syndrome (2.5%) each. Common risk factor for resistant hypertension were Tobacco use (35%), Smoking (32.5%), alcohol (10%), Sedentary life style (7.5%), Chronic NSAIDs use (2.5%) and High salt diet (2.5%). Effective management of resistant hypertension requires careful examination for and exclusion of factors associated with pseudo resistance, identification and when possible, modification of factors related to true B.P. elevation.