Therapy Resistant High Blood Pressure

[SHG__0]

  My husband is being treated for hbp since June/98. He has been on both
  ace inhibitors and beta blockers from low to high doses. At this point
  his pressure has remained unchanged. It averages between 150/95 - 170-112.
  He is on the highest dose of atenolol(?). He has been on 100mg. for
  approx. 1 week now with no change. I have several concerns at this point.
  His weight, diet is good. He moderately exercises, stress level is high.
  1. He may have had undetected hbp for any length of time previous to
    June.
  2. Since June there has been no change which is prolonging the condition
  with possible effects?
  3. What normally causes resistance to the medication and what
  could be causing it and could there be permanent organ damage?
  I am concerned about the time lag and am not sure is he should be
  seeing a specialist at this point.
  Your advice is appreciated!

[CCF Cardio MD - MTR]

Dear SHG, thank you for your question. Often, hypertension is difficult to treat and requires multiple medications to adequately control.  Beta blockers and ACE inhibitors are excellent antihypertensive medications, but many people don't respond fully to one or both of these medications. Your husband may not be resistant to beta blockers since the antihypertensive effect of this medication is often synergistic with other medications.   I think the next step would be to maximize the dose of the ACE inhibitor and then if that isn't adequate, add a third medication called a diuretic.  It's important to control the BP quickly as you surmised, but there is a run-in phase with new medications to reach the maximum drug effect.  The organs to be concerned about with chronic hypertension are the brain, eyes, heart, and kidneys.  You should ask your husband's physician if he has evidence of damage of any of these organs at his next visit.   There is a risk of permanent end organ damage, but I can't estimate that risk without examining your husband.

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
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