Resistant Hypertension: A Clinical Perspective

In India cardiovascular diseases (CVD) are epidemic and the largest cause of deaths. The Million Death Study in India reported that in years 2000-2003 CVD’s caused 20% of the more than 10.5 million annual deaths. The absolute numbers of deaths (about 2.1 million) are highest in the world and significantly greater than USA and other large countries1. Major CVD risk factors are as important in India as in other countries. Both INTERHEART and INTERSTROKE studies have reported that common risk factors are important2. Population-based epidemiological studies have reported that all major risk factors especially smoking, obesity, hypertension, hypercholesterolemia and diabetes have increased by 2-5 times in the country over last 50 years. Hypertension is a major risk factor and recent studies have reported a high prevalence in both urban and rural areas3. In urban areas the prevalence varies from 30%-45% in different regions (Figure 1). These findings are consistent with other developing countries in Asia and elsewhere where it has been reported that, at any one time, about half of all individuals have high blood pressure (BP). Epidemiological studies report that currently 70% of hypertension in India is stage I or mild hypertension diagnosed by systolic BP 140-159 and/ or diastolic BP 90-99 mm Hg while rest of the subjects have stage II hypertension. These studies also show that there are more than 65 million hypertensive subjects in India with more than 20 million stage II hypertensives requiring aggressive therapies.