Multidisciplinary Lifestyle Interventions In The Management of Resistant Hypertension

Resistant hypertension renders patients refractory to pharmacological treatment and is closely associated with excess weight and high cardiovascular risk. Resistant hypertension and obesity-associated hypertension share highly interrelated and interacting pathogenic mechanisms exacerbated by adiposity that propagate end organ damage including chronic kidney disease and cardiovascular disease. Perhaps it is time to contemplate in the overall management of hypertension, invasive procedures focused on weight loss. Lifestyle interventions improved results from pharmacotherapy alone in a cohort of patients with resistant hypertension. After 6 months of intensive multidisciplinary care, we found significant reductions in blood pressure, body mass index, and antihypertensive medication burden with improvement in cardiovascular disease biomarkers. Increased physical activity and weight loss appeared to be significant factors. Weight-loss drugs are generally ineffective but the impact of laparoscopic sleeve gastrectomy in another cohort of patients with obesity grade 3 and hypertension, was relevant with hypertension remission in more than 50% of cases and significant reductions in blood pressure and medication burden in those who remained hypertensive. Our results suggest the need to define in future studies and selected patients the potential role of combining medical multidisciplinary care with surgical interventions in the management of patients with resistant hypertension and high cardiovascular risk.