Resistant hypertension: Why our blood pressure stays high despite medication, explained by a senior cardiologist

High blood pressure impacts around one in every four adults in India and leads to over 1.6 million deaths annually. While it can be effectively managed through a combination of medication, dietary changes, and physical activity for many people, for a growing segment of patients, these efforts are not enough. These individuals, despite being on multiple medications continue to have uncontrolled blood pressure. This characterises a condition known as Resistant Hypertension.

Uncontrolled blood pressure is frequently thought to be caused by excessive stress or a diet high in salt. Although both are known contributors, resistant hypertension points to a deeper, more complex issue—one that frequently goes unrecognized or misunderstood. Let's take a look...




When Blood Pressure Won’t Come Down

Resistant hypertension is defined as blood pressure that stays elevated despite being on three or more medications, including a diuretic. It’s estimated to affect around 10% of people with high blood pressure—which, in India’s case, could mean millions.

Patients are advised to give their medication “more time”. Medication compliance is an issue that patients struggle with most, either due to side effects, cost, or simply the burden of multiple daily pills. In India, around 8.5% of people with hypertension have their blood pressure under full control, out of 52.5% who taken treatment.

A Newer Option

When medications and lifestyle changes still aren’t enough, newer, non-drug treatment is beginning to offer hope. Renal Denervation (RDN) is a minimally invasive procedure which is now readily available in India as an adjunctive to Resistant Hypertension treatment. It uses radiofrequency to target the overactive sympathetic nerves in the renal arteries — nerves that play a central role in regulating blood pressure. By calming this system down, RDN can help bring blood pressure levels down significantly, especially in patients who haven’t responded to medication alone. It is an important step forward in the management of resistant hypertension. This procedure usually takes 45-60 minutes, and most patients return home the same day or next day.

If your blood pressure medications aren't working, it is time to look beyond conventional pharmacological therapies. Discuss your treatment experience with your doctor, and whether a procedure such as RDN might enable you to get ahead of the disease, before it results in severe complications leads to heart attack, stroke or kidney failure.

This may be considered for patients who are diagnosed with resistant hypertension. People whose systolic pressure remains high (≥140 mm Hg in the clinic or ≥135 mm Hg on daytime ambulatory monitoring) despite taking at least three medications, including a diuretic, are considered primary candidates. They should also have relatively healthy kidney function and no significant abnormalities in the renal arteries. It is also essential that other causes of hypertension—such as thyroid problems, adrenal tumors, or certain medications—have been ruled out through proper evaluation.

Resistant hypertension is not rare, and it’s not simply a matter of non-compliance. Recognizing it as a distinct medical condition is the first step toward better outcomes. With greater awareness, better clinical evaluation, and newer treatments like renal denervation, patients don’t have to remain stuck in a cycle of trial and error and take control of their health. Renal denervation is not a replacement for healthy lifestyle habits or medications. Instead, it represents a promising adjunctive therapy— an option that empowers both patients and physicians with more tools to fight hypertension. As guidelines evolve and long-term data continue to accumulate, RDN may soon move from being a “last resort” to an earlier consideration in the treatment pathway. For those still searching for answers, it may be time to look beyond stress or salt— and to have a deeper conversation with your doctor about what comes next.

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Disclaimer: Issued in Public Interest. All information contained herein is for general awareness purposes only and not intended to act as medical advice. Patients should consult with their physicians in relation to their condition

(Dr Chandrashekhar Narayan Makhale, Senior Intervention Cardiologist, Director, Cardiac Cath Lab, Ruby Hall Clinic, Pune)