Diabetics Face Increased Treatment-resistant Hypertension Risk

The relatively high rate of major adverse cardiac and cerebrovascular events seen in patients with diabetes and treatment-resistant hypertension in this study is worrying, but several different approaches could potentially improve outcomes in these patients.

Dr. Per-Henrik Groop

The clearest message is that physicians need to do a better job getting their hypertensive patients to take all their prescribed medications. Patients who need four drugs to control their blood pressure will often take only a fraction of the pills they are supposed to take. A lot of treatment-resistant hypertension results from poor patient compliance or physician negligence.

Another option that my colleagues and I have recently explored is slow breathing, at a rate of about 15 breaths per minute, as is often done in yoga. My associates and I published results 2 years ago showing that deep breathing can improve the blunted baroreflex sensitivity often seen in patients with diabetes (Diabetologia 2011;54:1862-70). This approach may also be effective for reducing blood pressure in patients who are not ideally responsive to antihypertensive drugs. With deep breathing, patients can exert some control over their autonomic nervous system.

Another nondrug option is renal denervation, but for the time being I see this as a last resort. I have reservations about widely using renal denervation right now because I believe it remains investigational. There is no way to assess the effect of denervation treatment at the time it is delivered, the long-term consequences of the treatment are not yet fully known, and in many patients the effect is modest, especially when measured with ambulatory blood pressure monitoring. For some patients with treatment-resistant hypertension, renal denervation may be the only option for getting their blood pressure to their target level, but for the time being, I would use it very cautiously.

Dr. Per-Henrik Groop is professor and head of nephrology at the University of Helsinki (Finland). He made these comments in an interview. He has been a consultant to, or a speaker on behalf of, Boehringer Ingelheim, Novartis, Cebeix, Novo Nordisk, Merck, Abbott, Genzyme, and Eli Lilly.