Bhopal, 16 May, 2016: Refractory or Resistant Hypertension is a treatable disease. It is a condition in which blood pressure remains uncontrolled in spite of giving three or more anti hypertension medicines to the patient. These patients are at increased risk for cardiovascular disease, stroke, diabetes mellitus, and renal dysfunction, and they are also more likely to experience target organ damage, because of the potential complications caused by elevated blood pressure. The complications of Refractory Hypertension include cardiovascular disease, stroke, diabetes mellitus, or chronic kidney disease.It is difficult to manage Refractory Hypertension in patients having black and brown complexion, oldage, diabetes and kidney disease and obesity.
Renal Sympathetic Deneration (RSDN) and Baroreceptor Pacemaking are two latest therapies to effectively control this condition.Although preventive care and timely and strict adhrence to prescribed medicines are the best remedy.
Dr. Deepak Chaturvedi, renowned physician and director Akshay Heart Hospital, informed this while addressing a press conference on the eve of World Hypertension Day. He said there are three reasons which lead to Refractory Hypertension. First one is related to patients’ negligence towards medication. Taking medicines irregularly, reducing doses or stopping the medicines are some of them. Making no changes in lifestyle and continuieing with the consumption of alcohol, tabacco and junk food worsen the problem. Second reason has a connection with the physicians who prescribes low doses, less number of medicines than required and not precribing medicines as per patient condition and need. Third reason is spurious or poor quality medicines that do not deliver desired results.
He said Renal sympathetic denervation (RSDN), or renal denervation (RDN), is a minimally invasive, endovascular catheter based procedure using radiofrequency ablation or ultrasound ablation aimed at treating resistant hypertension (high blood pressure not controlled by medication).Nerves in the wall of the renal artery are ablated by applying radiofrequency pulses or ultrasound to the renal arteries. This causes reduction of sympathetic afferent and efferent activity to the kidney and blood pressure can be decreased.
While talking about baroreceptor implantable device Dr. Chaturvedi explained this device detect changes in your blood pressure and stimulates carotid baroreceptors to decrease sympathetic outflow to reduce the blood pressure. He further simplified that baroreceptors are specialized nerve endings that are built to detect a change in pressure or tension and relay that information to the brain through the neurons in the nervous system. It helps brain to sense blood flow and blood pressure in the major blood vessels of your circulatory system. It helps to adjust the blood flow in the organs and keep the blood pressure under control.
In order to do better management of the disease Dr. Chaturvedi also suggested Ambulatory Blood Pressure Monitory of the patient. With the help of this small device a 24 hour track record of patient is obtained. Ambulatory blood pressure monitoring (ABPM) measures blood pressure at regular intervals. It is believed to be able to reduce the white coat hypertension effect in which a patient’s blood pressure is elevated during the examination process due to nervousness and anxiety caused by being in a clinical setting.