Common Causes of Uncontrolled Hypertension

What Is Uncontrolled Hypertension?

Uncontrolled high blood pressure is also called resistant hypertension. It refers to a condition when the blood pressure of an individual remains high or uncontrolled despite taking medications to control it. Hypertension or high blood pressure is one of the critical health issues. But what is more condemning is when the condition of the patient does not improve even with the proper treatment. Such patients are at a greater risk of having a stroke, renal disease, and cardiac arrest than those who respond well to the medications.

What Are the Signs and Symptoms of Uncontrolled Hypertension?

Uncontrolled or resistant hypertension manifests itself in the following ways:

• When the blood pressure stays high, above 130/80 mmHg, even after taking three doses of anti-hypertensive medications, which includes one diuretic too.

• When the patient takes four or more anti-hypertensive drugs to achieve normal blood pressure.

• When there exists a secondary cause or an underlying medical condition, that prevents medications to control high blood pressure.

What Are the Causes of Uncontrolled Hypertension?

Most hypertensive people worry about their blood pressure not being controlled, and they visit the emergency room and clinic again and again. The reasons for uncontrolled hypertension are:

• People do not regularly take antihypertensive medicines, they take them for a few days, and once the blood pressure normalizes, they quit. After a few days, their blood pressure shoots up again.

• The other reason is patients do not follow dietary guidelines to control blood pressure. They eat without reins. They do not limit salt intake, fatty, and junk foods.

• Many a time, they adhere to medicines and diet, but still, come to the emergency department for raised blood pressure. In such cases, the blood pressure is raised due to a panic attack, acute anxiety, and sudden awakening from sleep such as after a nightmare. In such cases, medicines do not need to be changed, but only relaxation and counseling by family members may be all that is required in order to normalize the pressure. After which, continue taking the same medicines at the prescribed doses.

• Sometimes, blood pressure is controlled with one medication, but after some time such as a few years, the blood pressure rises again even with medicine. For this, the doctor increases the dosage of that medicine or adds another tablet.

• Sometimes, taking some medicines for cold, pain, etc., may raise blood pressure. In such cases, blood pressure should be closely monitored, and the dose of the antihypertensive medicines may be increased for a few days and again reduced back to the previous dose, once the offending medication is discontinued.

Remember, only pills cannot control blood pressure when there is no family support, when one is not self-conscious, or when one does not have enough knowledge about this condition.

Other factors that can lead to uncontrolled hypertension are:

Lifestyle and Diet: The following aspects can contribute to the occurrence of both hypertension and uncontrolled hypertension:

1. Obesity.

2. Sedentary lifestyle.

3. A high salt intake.

4. Alcohol abuse.

5. Drugs and Medications: Several drugs, whether prescribed or over-the-counter, can lead to deficient control of blood pressure. Such medications are:

• Painkillers, particularly NSAIDs (non-steroidal anti-inflammatory drugs) such as Ibuprofen and Naproxen.

• Nasal decongestants.

• Birth control pills or oral contraceptives.

• Herbal food items like ginseng, licorice, etc.

Secondary Causes: Sometimes uncontrolled hypertension develops due to secondary causes also which contribute greatly to raising blood pressure. Some of them are listed as:

• Primary hyperaldosteronism which occurs because of increased production of specific hormones from the adrenal glands.

• Renal artery stenosis results due to the narrowing of the arteries of the kidneys.

• Chronic renal disease.

• Sleep apnea.

• Certain less common causes are pheochromocytoma which is an adrenal gland tumor; aortic narrowing; and Cushing syndrome, which occurs due to overproduction of certain steroid hormones.

How Is Uncontrolled Hypertension Treated?

To know the causative factor, the doctor advises investigations for kidney disease or increased hormone production from the adrenal gland. Imaging tests of the adrenal gland or kidneys may also be recommended to check their condition and the renal stenosis. A sleep test may also be required to know if sleep apnea is present or not. Additionally, a test for hypothyroidism may also be needed as hypothyroidism can also lead to high blood pressure.

Lifestyle changes can aid in improving the control of blood pressure. These measures include:

• Restricting salt and alcohol consumption.

• Limiting the intake of NSAIDs as a painkiller. Acetaminophen can replace them.

• Engaging in aerobic activity for at least 30 minutes a day, 3 to 4 times a week.

• Treating sleep apnea with devices that provide continuous positive airway pressure.

In more than one-third of uncontrolled hypertension cases, antihypertensive drugs do not work because of their improper intake. For the drugs to be effective, they must be taken in the recommended dose and also the prescribed number of times every day.

If the patient suffers from resistant hypertension in spite of taking all the medications as prescribed then let the doctor know about it, for he may include an additional drug to the list. The most commonly used anti-hypertensive drugs are diuretics, calcium channel blockers, and ACE inhibitors or angiotensin receptor blockers (ARBs).

Scientific studies claim that the intake of Chlorthalidone, a diuretic, acts as an adjunct to anti-hypertensive drugs in treating hypertension. Another diuretic, an aldosterone antagonist like Spironolactone may aid in controlling high blood pressure.

If, due to any reason, the patient finds it troublesome to take the medicine as prescribed, talk to the doctor about it. He would help in solving the issue that prevents the patient from taking all the advised doses. If adverse effects occur due to any drug then the doctor may replace it with a better option. The doctor may even switch to medicines that need to be taken just once daily. It is important to understand the medications should not be discontinued due to any reason or as advised by the doctor. One can consider getting online prescriptions to avoid any breaks between the course of medication.

Conclusion:

Uncontrolled hypertension is a critical life-threatening issue that should not be ignored. The hypertensive patients should keep a regular check on their blood pressure readings and consult their treating doctor immediately if resistant hypertension develops. Resistant hypertension can be managed with the proper understanding of its cause, lifestyle alterations, and modifications in prescribed medications, if required.