For most people diagnosed with high blood pressure, lifestyle changes and medication work well together to bring their readings under control. But for some, despite doing everything right, eating healthy, exercising, cutting back on salt, sleeping better, and staying regular with medication, those blood pressure numbers simply refuse to come down. This persistent, hard-to-treat form of high blood pressure is known as resistant hypertension.
Doctors define resistant hypertension as blood pressure that remains above 140/90 mmHg even after taking three or more antihypertensive medications (including a diuretic) at optimal doses. In simpler terms, it’s when blood pressure doesn’t respond to standard treatment, even when the patient is doing everything correctly.
“For many patients, resistant hypertension can be incredibly frustrating. They’re following the rules, eating right, exercising, sleeping better, yet their readings won’t improve,” explains Dr Rohith P Reddy, Consultant Interventional Cardiologist, Yashoda Hospitals, Hyderabad. “It’s not about willpower or neglect. In such cases, we need to look for deeper triggers that keep blood pressure elevated, one of the most common being sleep apnea.”
When the Body Can’t Breathe, the Pressure Builds
One of the most overlooked causes of resistant hypertension is obstructive sleep apnea (OSA), a chronic sleep disorder in which the upper airway collapses repeatedly during sleep. This causes brief pauses in breathing, often without the person realizing it. Each episode lowers oxygen levels in the blood, forcing the body to jolt awake to resume breathing.
This repeated cycle of oxygen drops and awakenings, known as intermittent hypoxia, places the body under stress night after night. The heart rate spikes, stress hormones surge, and blood vessels constrict, keeping blood pressure persistently high.1 Over time, this constant strain doesn’t just affect sleep quality, it resets how the body regulates blood pressure.
Dr Reddy added, “The drop in oxygen activates the sympathetic nervous system—the body’s ‘fight or flight’ response, causing blood vessels to stay tight and blood pressure to remain elevated, even during the day.”
The Sleep-Hypertension Connection
The connection between sleep apnea and resistant hypertension is now well established. Several studies have shown that sleep apnea is one of the strongest risk factors for developing this condition. In fact, up to 83% of patients who visit hypertension clinics with resistant blood pressure are found to have undiagnosed sleep apnea.
Research by Gonçalves and colleagues found that people with sleep apnea have five times higher risk of developing resistant hypertension compared to those who sleep normally. This link is especially concerning because many people with OSA remain unaware of their condition. Loud snoring, choking or gasping during sleep, unexplained fatigue, and morning headaches are often dismissed as minor sleep issues rather than signs of a deeper cardiovascular problem.
When Fixing Sleep Isn’t the Full Cure
Addressing sleep apnea, through weight management, sleep posture correction, or using a CPAP (continuous positive airway pressure) machine, can significantly improve blood pressure control in many cases. However, for some patients, even after treating sleep apnea, hypertension remains resistant.
This happens because the body’s sympathetic nervous system, which was overstimulated during years of untreated sleep apnea, continues to remain overactive. The blood vessels stay constricted, and blood pressure doesn’t normalize despite optimal medication and lifestyle efforts.
“Even after treating sleep apnea, some patients find their blood pressure remains high,” adds Dr Reddy. “That’s when we start considering advanced options. It’s not about adding more pills, it’s about addressing the root cause of nerve overactivity that drives blood pressure.” For patients whose blood pressure remains uncontrolled despite addressing contributing factors like sleep apnea, obesity, or medication interactions, new therapies such as Renal Denervation (RDN) are offering renewed hope.
If you snore loudly, feel exhausted even after a full night’s rest, or have persistently high blood pressure despite medication, it’s worth asking your doctor about screening for sleep apnea and resistant hypertension. And if lifestyle changes and sleep management still don’t bring your readings down, discussing advanced options like RDN may be the next logical step. By combining good sleep habits, appropriate treatment for sleep apnea, and innovative therapies when needed, patients can finally take control of even the most stubborn blood pressure, and reclaim the rest their body truly needs.
(Views expressed by experts in the articles are their own; Zee News does not confirm or endorse the same. This article is meant for informational purposes only and must not be considered a substitute for advice provided by qualified medical professionals. Always seek the advice of your doctor with any questions about diabetes, weight loss, or other medical conditions.)
