Resistant Hypertension and Social Determinants of Health

By Shawna D. Nesbitt, M.D., M.S.

Professor of Internal Medicine
Vice President and Chief Diversity, Equity, and Inclusion Officer

Resistant hypertension is estimated to be present in 8-12% of all patients with hypertension. Indeed, despite multiple classes of medications and a recent consensus statement with a treatment algorithm, many patients still fail to reach blood pressure goals.

At #AHA22, a roundtable, case-based session focused on resistant hypertension and included discussions on the guidelines for treating hypertension, emerging therapeutic options, and real-world cases of patients with resistant hypertension. New therapies including baxdrostat, an inhibitor of aldosterone synthase, and renal denervation, offer great promise as therapeutic options for patients with resistant hypertension.

Managing resistant hypertension is more than just understanding the mechanistic approach to lower blood pressure. Rather, a comprehensive assessment of the complex circumstances patients experience in their everyday life – which might lead to resistant hypertension – is needed. In particular, the social determinants of health are key factors in the development of hypertension, as well as in the successful implementation of "Life’s Essential 8,” and in patients’ adherence to the treatment plan. Furthermore, the life challenges faced by many patients limit their access to novel therapeutic measures, such as renal denervation, as well as their availability for undergoing the complex workup of some causes of secondary hypertension.

Our role as physicians is to be problem solvers rather than reporters of data. A comprehensive assessment of the social determinants of health should accompany the implementation of the treatment guideline algorithm to assess and control resistant hypertension. Such an approach will help us achieve the goal of reducing the cardiovascular and cerebrovascular consequences of severe hypertension in all patients.

Email: shawna.nesbitt@utsouthwestern.edu

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