Apparent treatment resistant hypertension. The drug could be culprit

Abstract

Treatment of hypertension to goal should be the goal if its morbi-mortality consequences are to be curtailed. Notwithstanding, this ideal however, sub-optimal control plagues clinical practice largely due to non-adherence, adverse side-effects, and outright intolerance. When there is apparent treatment failure, the tendency is to consider these. If adjudged to be resistant or refractory to treatment, device therapy is contemplated notwithstanding cost implications and its invasive nature. Little attention is paid to the phenomenon of paradoxical hypertension, wherein in the presence of certain antihypertensives, blood pressure actually rises rather than falls. How much of this that occurs in clinical practice is not exactly known, but continuing to add new drug classes or increase doses in such situations will increase cost and possibility of side effects without optimal control. Target organ damages would persist with worse outcomes. The evolving area of pharmacogenomics is showing that for some genetic reasons, certain individuals would respond to certain drugs and not others. This may manifest in the occasional instances of paradoxical rise in blood pressure with the introduction of certain blood pressure drug classes. The authors encountered a few such cases and considered them of interest to other clinicians who manage difficult to treat hypertension. When hypertension treatment is sub-optimal especially rising with new drug introduction, it may be worth switching drugs just in case a paradoxical response to a drug class is responsible for non-response.