High blood pressure--also known as hypertension--is widespread, but treatment often fails. One in five people with hypertension does not respond to therapy. This is frequently due to inadequate diagnosis, as Franz Weber and Manfred Anlauf point out in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2014; 111: 425-31).
If a patient's blood pressure is not controlled by treatment, this can be due to a number of reasons. Often it is the medication the patient is on. Some patients may be taking other medicines - in addition to their antihypertensive therapy - which increase blood pressure as a side effect. In these cases, the treatment of the high blood pressure appears to be ineffective, but all that would be needed is some adjustment to the medication regimen. Then there is diet. Licorice, for example, does increase blood pressure; so eating too much of it may reduce the effect of the antihypertensive therapy. Likewise, salt-sensitive patients may increase their blood pressure by eating salt; thus they have to keep this in mind when seasoning their dishes.
Besides drugs and food, certain symptoms may interfere with antihypertensive therapy. Once the underlying condition has been successfully treated, blood pressure control does often improve. An example for this is the sleep apnea syndrome: Apart from sleep problems and fatigue, it makes high blood pressure worse. Here, most patients find their blood pressure improved with targeted treatment of the apnea and quite often the antihypertensive medication can be reduced.
Thus rigorous diagnostic evaluation is key to a successful treatment of hypertension. In their current study the authors expect that with this approach almost half of the cases classified as treatment-resistant hypertension could be treated.