Resistant Hypertension In India: The Silent Threat Behind Uncontrolled High Blood Pressure; Know From Doctor

High blood pressure has long been a pressing public health concern in India, but within this broader issue lies a more silent and stubborn condition, resistant hypertension. Unlike regular hypertension, resistant hypertension occurs when blood pressure remains uncontrolled despite the use of at least three different types of antihypertensive medications, including a diuretic. Studies suggest it affects around 10 per cent of people with high blood pressure, but it often goes unrecognised or misdiagnosed. In India, where hypertension affects roughly 1 in 4 adults, this could translate into millions of people whose blood pressure simply isn’t responding to standard treatment.

What makes resistant hypertension particularly dangerous is that it hides in plain sight. Patients and even doctors may dismiss it as “regular BP taking time to stabilise,” overlooking the need for deeper evaluation. While factors like poor adherence, stress, and lifestyle habits play a role, the condition often demands more comprehensive management, from ruling out secondary causes to considering newer interventions like Renal Denervation (RDN). In conversation with The Daily Jagran, Dr Amit Bhushan Sharma, Director & Head, Intervention Cardiology,
Paras Hospital, Gurugram, shares how resistant hypertension has become a silent threat.

What Is Resistant Hypertension?

This condition, where blood pressure remains elevated despite the use of at least three different types of antihypertensive medications (including a diuretic), is far more common than many realize and far less talked about than it should be.

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A Condition Hiding In Plain Sight

Resistant Hypertension isn’t rare. But we rarely hear about it—in clinics, in policy discussions, or in public awareness campaigns.

Dr Amit Bhushan Sharma states, “Part of the problem lies in underdiagnosis. Many people with difficult-to-treat hypertension are never formally recognised as having resistant hypertension.” Often, it's blamed on poor adherence, lifestyle factors, or stress. And while these are real contributors, the physiological complexity of resistant hypertension often gets overlooked.

Why It Matters

Uncontrolled hypertension, including resistant hypertension, is one of the leading causes of heart attack, stroke, and kidney disease in India. When blood pressure remains elevated despite optimal treatment, it signals a greater risk of cardiovascular events, faster target organ damage, and a heavier long-term health burden.

Resistant Hypertension In India (Image Credits: Canva)

Dr Amit Bhushan Sharma states, “What makes it even more dangerous is that it often masquerades as “just regular high BP” that’s “taking time to settle.” Patients may be asked to “wait it out,” while the disease quietly progresses.”

India’s public health efforts around hypertension have focused commendably on screening and early detection—but resistance is not just about detecting more cases; it’s about treating them better. We need protocols that go beyond the basics.

Rethinking Treatment

Managing resistant hypertension isn't just about prescribing more pills. It involves asking deeper questions - Could there be a secondary cause that has been missed? Is the patient truly adherent, or are there barriers to taking medication regularly? Are lifestyle interventions - especially reducing salt intake, weight loss, and sleep hygiene - being optimised? Has ambulatory blood pressure monitoring been done to rule out white coat hypertension?
Dr Amit Bhushan Sharma mentions, “In India, where treatment inertia and time-pressed consultations are common, these steps often fall through the cracks. Additionally, there are emerging interventional therapies like Renal Denervation (RDN), that are showing hope for patients who remain hypertensive despite optimized medical therapy.” Though still being adopted cautiously, especially in resource-constrained settings, these non-pharmacologic approaches offer a valuable alternative for those running out of options.

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It's imperative for our public health discourse to openly and urgently address resistant hypertension. We must raise awareness among general practitioners so they can flag and refer suspected cases earlier. Public health messaging should educate patients on the importance of adherence and regular monitoring, while health systems should make space for deeper assessments—and not just prescription renewals. National hypertension guidelines must expand to include resistant hypertension management protocols and recognise the value of newer technologies and treatment pathways, including Renal Denervation, where feasible. Lastly, we need more local research to understand the Indian phenotype of resistant hypertension, its triggers, and the interventions that work best in our context. By openly addressing this condition, we can shift care towards focusing on quality of treatment, not just quantity and take control of our own health.