Volume : 6, Issue : 5, May - 2017

Clinical Evaluation of Patients of Resistant Hypertension

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

Abstract :

<p>&nbsp;<span style="font-family: &quot;Times New Roman&quot;, serif; font-size: 14pt;">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. (</span><u style="font-family: &quot;Times New Roman&quot;, serif; font-size: 14pt;">&lt;</u><span style="font-family: &quot;Times New Roman&quot;, serif; font-size: 14pt;"> 140/90 mm Hg for the overall population &amp; </span><u style="font-family: &quot;Times New Roman&quot;, serif; font-size: 14pt;">&lt;</u><span style="font-family: &quot;Times New Roman&quot;, serif; font-size: 14pt;"> 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 diuretic</span><sup style="font-family: &quot;Times New Roman&quot;, serif;">1</sup><span style="font-family: &quot;Times New Roman&quot;, serif; font-size: 14pt;">. Causes of true resistant hypertension include Chronic Kidney Disease (CKD), Obesity, obstructive sleep apnea, volume over load, drug induced hypertension NSAID use, excessive alcohol intake</span><sup style="font-family: &quot;Times New Roman&quot;, serif;">2</sup><span style="font-family: &quot;Times New Roman&quot;, serif; font-size: 14pt;">.</span></p> <p class="MsoNormal" style="text-align:justify;text-justify:inter-ideograph;&#10;line-height:200%"><span style="font-size:14.0pt;line-height:200%;font-family:&#10;&quot;Times New Roman&quot;,serif">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 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%), <st1:stockticker w:st="on">SLE</st1:stockticker> (5%), Coarctation of aorta (2.5%) , COPD (2.5%) and lgA Nephropathy &amp; 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&nbsp; B.P. elevation. &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;<o:p></o:p></span></p>