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Hypertension aids: what to do if hypertension is difficult to adjust?


What measures help with hypertension that is difficult to adjust
Hypertension is a common ailment that can cause many serious complications. When diagnosing high blood pressure, therapeutic countermeasures should therefore be initiated urgently. However, the blood pressure in 65 percent of high-pressure patients does not remain adequately controlled, reports the German Society for Nephrology (DGfN) and based on current study data. Professor Martin Hausberg explained at the 9th annual conference of the DGfN what causes this can have and which measures can help with hypertension that is difficult to adjust.

According to the expert, difficult to adjust high blood pressure can have different causes and there is not always a "real" resistance to therapy. First of all, the reasons for the problems should be determined in order to then take targeted countermeasures. If the usual methods fail to lower the blood pressure values ​​in the target area, the patient should be referred to a nephrologist / hypertensiologist, according to the DGfN.

Hypertension is a significant risk factor
According to the German Society for Nephrology, high blood pressure is one of the most important cardiovascular risk factors (arteriosclerosis) with potentially fatal consequences such as a stroke or heart attack. In addition, the risk of blindness and damage to the kidneys increases. Conversely, kidney diseases are associated with high blood pressure in most cases, so that kidney diseases and hypertension are mutually dependent and intensify, the experts report. The underlying mechanisms are varied and complex.

Connection between kidneys and high blood pressure
For example, there is a connection between hypertension and kidneys through the regulation of volume and electrolyte balance (excretion of salt and water), the endocrine functions of the kidney (production of blood pressure-relevant hormones; renin-angiotensin-aldosterone system) and the direct interaction of the kidneys with the kidney sympathetic nervous system. For patients with chronic kidney disease (CKD), "lowering blood pressure or adjusting blood pressure is crucial for slowing down the disease process and can prolong dialysis-free life," the DGfN announcement.

Therapy-resistant hypertension
According to the DGfN, hypertension is considered to be therapy-resistant if, despite an antihypertensive triple combination (in maximum dosage according to the guidelines including a diuretic), it cannot be reduced to the target area. In such cases, the first step is to find out why the hypertension is difficult to adjust. Sometimes there is not a "real" resistance to therapy, but there could be other reasons, said Professor Martin Hausberg, past president of the German Hypertension League and congress president of the 9th annual conference of the German Society for Nephrology (DGfN).

White coat hypertension is a possible cause
The expert cites the so-called “white coat hypertension” or practice hypertension as possible causes for the difficult to set blood pressure values. According to international studies, this forms the cause of an apparent non-response of the hypertensive therapy in 12 to 34 percent of those affected. A 24-hour blood pressure measurement can be used to ensure that this is not a form of hypertension.

Adherence problems with far-reaching effects
According to Professor Hausberg, there may also be adherence problems, which can be difficult to determine. Inadequate patient adherence (implementation of the recommendations), for example in the case of general measures (low-salt diet, change of diet, weight reduction, abstaining from alcohol) and taking tablets, can have far-reaching effects. A recent study found that "up to 80% of patients did not take their medication as prescribed."

Secondary hypertension results from other diseases
According to the expert, if other problems can be ruled out, it is also necessary to check whether there is so-called secondary hypertension, which can occur, for example, through narrowing of the renal artery (renal artery stenosis, so-called renovascular hypertension). Sleep apnea syndrome is also often associated with (especially nightly) increases in blood pressure, as there are repeated sympathicotonic wake-up reactions due to hypoxia. In addition, there are drugs that can increase hypertension and the use of which may need to be weighed (e.g. estrogens, steroids, non-steroidal anti-inflammatory drugs / NSAIDs).

Invasive procedures the last option
If there is suspicion of therapy-resistant hypertension, the DGfN recommends referring the patient to a nephrologist / hypertensiologist. For example, after exclusion of white coat hypertension, adherence problems and secondary hypertension, treatment with multiple combinations of antihypertensive drugs can be tried, in which four, five or even six antihypertensive drugs are used in parallel. If this drug therapy is not sufficiently effective, invasive procedures can be used to treat therapy-resistant hypertension, for example with renal denervation or baroreflex stimulation. (fP)

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