239compounds, such as darusentan)) [ 16 ]. To summarize, a relevant or possibly the
main cause of pseudo-resistant hypertension appears to be nonadherence to pre-
scribed anti-hypertensives. The identification and removing of this factor provides
the normalization of BP levels and the ability of ruling out the resistant hypertension
diagnosis that prevents overtreatment and expensive or excessive evaluation.
How the Public Health Policies Promote Lifestyle
Interventions to Prevent Development of RHT
As the popularity of RHT is supposed to increase [ 3 ], effective treatments to enhance
results among individuals with RHT are required. Treatment methods being
researched for the management of RHT contain invasive, irreversible procedures or
implantable devices such as renal denervation and carotid baroreceptor stimulation.
Nonetheless, it is significant to specify the efficacy of less invasive approaches to
spare individuals the inconvenience and possible complications that come from
these procedures. Hypertension guidelines generally advise lifestyle changes,
including weight reduction, increasing physical activity, moderation of alcohol con-
sumption, adoption of the Dietary Approaches to Stop Hypertension (DASH) diet,
dietary salt reduction, and smoking cessation, as adjunctive therapy to antihyperten-
sive medication [ 2 , 4 ]. Partly, these advices rise from studies that have shown a
relation between lifestyle factors and morbidity/mortality among hypertensive indi-
viduals [ 29 , 30 ].
All patients with resistant hypertension should be advised on lifestyle changes to
lower blood pressure. Sodium intake is a great factor contributing to resistant hyper-
tension. Meta-analyses of clinical trials showed that sodium restriction to approxi-
mately 1.7 g/day was related with a reduction in office blood pressure by 5/3 mmHg
in patients with mild uncomplicated hypertension [ 31 ]. The antihypertensive effects
of sodium restriction are even more addressed in patients with resistant hyperten-
sion. In one study, 24-h ambulatory blood pressure was decreased by 23/9 mmHg
when sodium intake was shortened to 1.1 g/day in patients with unchecked blood
pressure on a 3-drug regimen that built a diuretic [ 32 ]. However, the average sodium
consumption in the USA is higher than the level recommended (8.5 g of salt per
day). Approximately 75% of the sodium consumed in the USA is acquired from
processed foods or restaurant cuisine. Circa 25% of consumed sodium is added at
meals [ 33 ]. Recommending the patients to read nutritional labels carefully is neces-
sary to limit sodium intake and have a better blood pressure control. Physical inac-
tivity has been specified in more than 40% of patients. Guidelines advised that
patients with hypertension should engage in at least 30 min per day of aerobic phys-
ical activity most days of the week [ 2 , 3 ]. A recent randomized trial containing
patients with resistant hypertension indicated that a training program, making up of
walking on a treadmill three times weekly for 8–12 weeks, significantly declined
ambulatory blood pressure by 6/3 mmHg compared with a sedentary control group
[ 34 ]. By this way, aerobic exercise should be suggested in most patients with resis-
tant hypertension.
15 Public Health Efforts for Earlier Resistant Hypertension Diagnosis...