Delhi study links uncontrolled hypertension to lack of awareness and poor habits

A study in Delhi reveals that patients with treatment-resistant hypertension often lack understanding and adhere poorly to medication, impacting control.

A study conducted by doctors at the University College of Medical Sciences and Guru Teg Bahadur Hospital in Delhi has found that patients whose high blood pressure remains uncontrolled despite taking multiple medicines often lack proper understanding of the disease and continue to follow unhealthy habits.

Representational image. (Shutterstock)

The study, titled “Comparison of Knowledge, Attitude and Practices among Apparent Treatment Resistant Hypertensive Patients and Non-Apparent Treatment Resistant Hypertensive Patients in a Tertiary Care Center,” published in the Journal of Clinical and Diagnostic Research, examined why some patients struggle to control their blood pressure even when they are on treatment.

Treatment-resistant hypertension refers to cases where blood pressure remains high despite the use of three or more anti-hypertensive drugs.

The research included 100 adult patients, of whom 50 had difficult-to-control blood pressure and 50 had their blood pressure under control. The participants were assessed on their knowledge about hypertension, their attitude towards the disease, and their day-to-day practices in managing it.

The findings revealed that patients with uncontrolled blood pressure were more likely to have gaps in understanding the seriousness of hypertension and the importance of strict adherence to medication. Many reported irregularly taking medicines, missing doses, or stopping medication without consulting doctors. A significant number also failed to reduce salt intake despite medical advice.

“We conducted the study in the hospital OPD. The case-control study was carried out in the Department of Medicine at University College of Medical Sciences and its associated Guru Teg Bahadur Hospital, Delhi, over three years. Subjects were recruited from the Medicine outpatient department and special clinics,” said Dr Amitesh Aggarwal, one of the main authors of the study. He added that consecutive adult hypertensive patients aged 18 years and above, who consented to participate and had been on antihypertensive medication for at least six months, were included.

“A lot of blood pressure patients do not realise that irregular use of medication, including skipping doses, stopping and restarting medicines on their own, or taking them only when they feel their BP is high, is one of the major causes of resistant hypertension,” Dr Aggarwal said.

The study further found that some patients consumed other over-the-counter or prescribed medicines alongside their blood pressure drugs without informing their physicians, which could interfere with treatment effectiveness. “Combining certain pain relievers, particularly non-steroidal anti-inflammatory drugs (NSAIDs), with blood pressure medication can significantly affect health by raising blood pressure and reducing the effectiveness of the prescribed drugs,” said Dr Aggarwal. Irregular monitoring of blood pressure was another common issue among patients with resistant hypertension, reducing opportunities for timely dose adjustments.

The findings of the study highlight that uncontrolled hypertension is not always due to drug failure alone but may also be linked to behavioural and awareness-related factors. The study stressed the need for stronger patient counselling, better education about long-term complications such as heart disease and stroke, and structured follow-up to improve treatment adherence.