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About 1 in 11 people who have high blood pressure has a condition known as resistant hypertension, which is high blood pressure that won't come down even with one, two, three, or sometimes ten medications. A new surgical procedure offers hope.

Robert just could not get his blood pressure under 180/140. First his doctor put him on common antihypertensive medication called propanolol. This beta-blocker slows down nerve stimulation to the heart and usually lowers blood pressure quickly, but Robert's blood pressure didn't budge.

Next Robert pulled off the impossible and managed to lose 72 pounds (about 33 kilos). This didn't help, either.

Robert's doctor put him on a second drug called lisinopril. This medication is perhaps the best known medication of a class known as angiotensin converting enzyme (ACE) inhibitors. These medications prevent the activation of an enzyme that makes the kidneys retain fluid to maintain blood pressure (which is a good thing during blood loss but not a good thing under ordinary circumstances). The doctor also put Robert on a medication called Imdur, sold under the generic name isosorbide mononitrate. This medication acts in a way similar to the "nitro" pills some people take for chest pain. It helps the linings of blood vessels relax to lower the pressure of the blood within them.

Then Robert managed to master a yoga discipline called pranayama breathing. He felt better, but his blood pressure did not go down.

One, Two, Even Three Drugs Together May Not Be Enough to Control Blood Pressure

The three drugs brought Robert's blood pressure down to 175/138. The doctor doubled the dosage, and added a fourth drug called Ranexa (ranolazine). This pricey medication changes the way heart and brain tissue respond to sodium, keeping them from "powering down" by absorbing too much sodium, sugar, and fluid. Ranexa helps the heart beat evenly.

That got Robert's blood pressure down to 160/130. Unfortunately, that is still a dangerously high blood pressure. The doctor then prescribed yet another medication called ticagrelor, which is sold in the United States under the trade name Brilinta. This drug stops the process of inflammation that can tighten blood vessels and increase blood pressure. The doctor would have put Robert on a medication called losartan, a drug that stops the kidneys from responding to the hormone angiotensin (an ACE-receptor blocker), but it would conflict with the Brilinta. The doctor also gave Robert nitroglycerin pills to put under his tongue when his chest hurt.

Even that was not enough, so the doctors put Robert in the hospital and gave him the same drugs in an IV. That intervention worked, bringing Robert's blood pressure to 90/60, as long as he stayed perfectly still in a hospital bed breathing oxygen through a face mask. There were still more medications to be tried, including aldosterone and spironolactone, but these drugs cause men to accumulate female hormones. There had to be a better way.

A Surgical Alternative to High Blood Pressure Drugs

Fortunately for Robert, there was a surgical alternative to all the high blood pressure medications that don't work, a relatively new procedure called renal denervation. This relatively new procedure has been used for several years in the UK and European Union to treat resistant hypertension. And unlike many other procedures for cardiovascular problems, renal denervation is not an especially traumatic procedure.

Continue reading after recommendations

  • Sharabi Y. Diabetes Metab Res Rev. 2012 Nov 20. doi: 10.1002/dmrr.2371. [Epub ahead of print]
  • Unger T, Paulis L, Sica DA. Therapeutic perspectives in hypertension: novel means for renin-angiotensin-aldosterone system modulation and emerging device-based approaches.Eur Heart J. 2011 Nov.32(22):2739-47. doi: 10.1093/eurheartj/ehr253. Epub 2011 Sep 27. Review. PMID: 21951628 [PubMed - indexed for MEDLINE]

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