Thursday, September 06, 2012

What To Do If Your Blood Pressure Refuses To Decline?

If a person’s blood pressure is too high, his or her heart has to work harder to pump. This can cause organ damage and lead to diseases including heart disease, stroke, aneurysm and renal failure. Hence, keeping one’s blood pressure below the normal range, which is 120/80 mmHg, is important.

Patients with high blood pressure (hypertension or sometimes called arterial hypertension) are usually prescribed with hypertensive medication. However, there are patients who are not responding to the medical treatments. These patients are said to have resistant hypertension, which is defined as hypertension that remains above target blood pressure in spite of concurrent use of at least 3 antihypertensive agents belonging to different antihypertensive drug classes.

In Germany, only 5 to 17 percent of patients treated for hypertension can achieve lasting control of their blood pressure. On the other hand, about 5 to 15 percent of all hypertensive patients have resistant hypertension.

A group of German researchers presented a set of treatment strategies for resistant hypertension in the July 25, 2011’s issue of ‘Deutsches Arzteblatt International’. They stressed that a multimodal interdisciplinary strategy involving systematic identification of secondary causes of hypertension and exclusion of pseudoresistance (inadequate treatment) is needed to successfully treat resistant hypertension.

Drug treatment must be tailored to individual patient and reversible or secondary causes of hypertension must be systematically sought and treated. This should be complemented by non-pharmacological conservative treatment measures including optimization of weight, a low-salt diet, physical exercise, and abstinence from alcohol.

Out of the 2 new partially still experimental therapy options, namely renal denervation and baroreceptor stimulation, researchers reviewed and suggested that renal sympathetic denervation can be used as an added treatment option for patients whose high blood pressure is inadequately controlled with medication.

Renal denervation, which is an interventional procedure with a low rate of complication, can help patients achieve significant and enduring reduction in blood pressure. The nerves in the vascular wall (adventitia layer) can be denervated by applying radiofrequency pulses to the renal arteries. This will reduce renal sympathetic afferent and efferent activity and blood pressure can hence be decreased.

Patients in German have to be enrolled in clinical registries and monitored at regular intervals following treatment for conclusive evaluation of the long-term effects and safety of this new approach. The German Renal Denervation (GREAT) Registry has been set up for this purpose.

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