Hi ,

How are you doing today?

Good blood pressure control saves lives — it lowers the risk of stroke, heart disease, kidney failure, sexual dysfunction, vision loss and dementia. Yet for many people, even with several medications, blood pressure stays above target.

A recent US study of over 500,000 people on 3 or more medications found:

1. Only 37.7% met the BP target of less than 130/80 mm Hg.
2. Was poor control simply because people weren’t taking their medications? Not entirely. Blood pressure was controlled in 43.0% of those who were adherent, compared with 39.4% of those who were not, a small difference.
3. Therapeutic inertia (the failure to intensify treatment despite not achieving target blood pressure levels) was common — 64.5% of patients with high BP had no medication changes within 18 months.
4. Specialist care (from cardiologists and endocrinologists) achieved better control, but paradoxically, their patients were less adherent than those under primary care. The researchers were unable to determine the causes.

Was this Resistant hypertension? Blood pressure that stays high despite three or more medications, including a diuretic, at proper doses, is called resistant hypertension. In such cases, doctors also look for other causes, like hormonal disorders, after confirming adherence. The researchers couldn't confirm this based on the data.

What this means for you:

1. Do you know your target blood pressure?
2. Do you check it at home with validated devices?
3. If your numbers remain high, please talk to your doctor — uncontrolled blood pressure can shorten life.

An ask:

I am developing a new program to simplify and make blood pressure control more sustainable. I’d love to hear your experience with hypertension in a short conversation (not a medical consultation).

💝 As a thank-you, you’ll receive early access to my Better Blood Pressure course.

If you’re interested, please book a slot here.

See you next week!

Best regards,

Shabnam

Dr. Shabnam Das Kar, MD

Functional Medicine Doctor

Tiny Habits Coach

Email: info@drkarmd.com

Reference: Mohl, Jeff T., et al. "Evaluation of Blood Pressure Control, Medication Adherence, and Therapeutic Inertia in US Patients With Hypertension Prescribed Multiple Antihypertensives." Journal of the American Heart Association 14.12 (2025): e034787.