Resistant hypertension can be defined as a blood pressure 140/90mmHg despite the use of 3 hypertensive agents or ≥ 4 antihypertensive agents. Primary care clinicians and specialists come across treatment resistant hypertensive patients quite frequently. While its exact prevalence is unknown, it is believed that 10 to 30% of hypertensive patients are resistant hypertensives.
A critical strategy that should be adopted by patients with apparent treatment-resistant hypertension is to maintain a healthy lifestyle. This can go a long way in preventing cardiovascular events, according to researchers. Keith Diaz of Columbia University Medical Center and his team report that undertaking physical activity as well as not smoking can have a significant impact on hard-to-treat hypertensive patients. While this has not been widely studied in such patients, Diaz's team stresses the importance of using less invasive approaches and sparing these hypertensive patients the inconvenience and complications of invasive and irreversible procedures.
2043 participants were evaluated in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Study patients had blood pressure of 140/90 mmHg or more. Patients had been treated with at least three classes of hypertensive drugs or required four classes of these drugs to keep their blood pressure in control. Over a period of 4.5 years, participants had 360 cardiovascular events. Patients were assessed on the basis of six healthy lifestyle factors. These include absence of abdominal obesity, moderate or no alcohol consumption, a healthy diet, low rate of sodium to potassium intake, non-smoking and physical activity.
Only physical activity and non-smoking were directly associated with cardiovascular outcomes. It was reported that there was a 46% reduction in risk of cardiovascular events with not smoking and a 33% risk reduction by undertaking physical activity at least four times a week. The other four factors were not shown to have an impact individually on cardiovascular outcomes in these patients. However, it was reported that the higher the number of healthy lifestyle factors, the lower the risk of cardiovascular events. Study patients that had four to six healthy lifestyle factors had a 37% less risk of a cardiovascular event compared to those that had one or no factor. A similar association was observed for all-cause mortality.
Results of this study prove that there are definite incremental benefits of adopting a healthy lifestyle for hard to treat hypertensive patients. Being physically active and not smoking can greatly reduce cardiovascular risk in such patients. Only 13.7% of the study population had four of the six healthy factors and by increasing the number of patients who actively adopt a healthy lifestyle, there is great potential of improving the lives of treatment resistant hypertensive patients.
Regular physical activity is also recommended by both European and American hypertension guidelines. Physical activity has been shown to decrease blood pressure in patients with low responsiveness to medical treatment and should be an integral part of the therapeutic approach to resistant hypertension. The guidelines encourage hypertensives to be regularly active by engaging in aerobic exercise including walking, jogging or swimming for at least 30 to 45 minutes daily.
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