Doctors in Kenya are increasingly seeing a rise in patients with resistant hypertension, a condition where blood pressure remains elevated despite the use of three different medications.
This growing trend is becoming a significant public health challenge, not only due to the medical complexities of managing the condition but also because of the financial burden.
Dr Karimi Nguchu, a cardiologist at Mwai Kibaki Hospital in Othaya, defines resistant hypertension as blood pressure that remains above 140/90 mmHg despite the use of three different blood pressure medications, including a diuretic (medicines that help reduce fluid buildup in the body).
“It’s a pattern we’re seeing more and more, but we don’t have solid national figures to quantify the burden,” she says.
At the Aga Khan University Hospital, Dr Etienne Amendezo, assistant professor and consultant interventional cardiologist, is seeing a similar trend.
“We see many cases of resistant hypertension, but the lack of data has made it difficult to fully understand the extent of the problem. Anyone can be at risk, especially hypertensive patients,” he says.
In response, the hospital recently set up a dedicated resistant hypertension clinic to collect data, track cases and improve management.
For patients with resistant hypertension, Dr Nguchu says, they require more intensive interventions, in addition to multiple, expensive drugs.
"Patients may require advanced interventions such as renal denervation, a surgical procedure that disrupts the sympathetic nerves surrounding the kidneys to control blood pressure, further increasing the financial burden," she says, adding that some antihypertensive drugs cost has doubled in the last five years, putting further strain on patients’ finances.
For patients with standard hypertension or diabetes, the monthly cost of medication can range from Sh1,500 to Sh5,000. In contrast, a patient with resistant hypertension can spend between Sh25,000 and Sh35,000 per month, depending on the number and type of drugs prescribed.
Dr Amendezo says for those with resistant hypertension, "it's not just about managing the high blood pressure; it's about addressing the multiple underlying factors that prevent effective treatment."
Resistant hypertension significantly increases the risk of serious cardiovascular complications such as stroke, heart attack, heart failure and chronic kidney disease.
Risk factors
Dr Etienne points to several factors that can increase the likelihood of developing resistant hypertension including obesity.
Others are chronic kidney disease, excessive salt intake, non-adherence to medication, genetic predisposition and lifestyle factors such as excessive alcohol consumption, smoking and lack of physical activity. Certain medications can also contribute to the problem.
"Before diagnosing resistant hypertension, it's important to confirm that the patient is adhering to his or her treatment plan," he says, adding,
"Non-adherence is an important factor because those who do not follow their prescribed treatment regimen are at higher risk of uncontrolled hypertension."
Hypertension is a major public health problem in Kenya, with a national survey showing that 28.6 percent of adults aged 18 to 69 have the disease that's also known as a "silent killer".
Despite the high prevalence, awareness, treatment and control rates remain low, contributing to the prevalence of the disease.
Maintaining a healthy weight, reducing salt intake and following a healthy diet can help control blood pressure and prevent the onset of resistant hypertension. Regular blood pressure checks are essential for early detection and treatment.
"Preventing resistant hypertension requires a combination of lifestyle changes [reducing alcohol consumption, quitting smoking and increasing physical activity] and adherence to prescribed medication," says Dr Etienne.
