World Stroke Day 2025: Chennai cardiologist warns of a ‘stubborn’ hypertension type that silently raises stroke risk

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Several studies have been conducted that established hypertension as one of the primary risk factors for stroke. One of the recent study published in Cardiovascular Diabetology in August 2025 further reinforced this link, that when hypertension is combined with elevated stress-related blood sugar levels, stroke risks spike significantly. Hypertension is such a dominant and well-established predictor that newer studies are now combining it with other biological markers to get an even better picture of the stroke risks.

While you are already aware of hypertension, there’s one type of hypertension that is stronger and dangerous, because it stays high even after taking multiple medications.

To understand this type of hypertension, HT Lifestyle reached out to Dr Babu Ezhumalai, senior consultant – interventional cardiology, structural and endovascular interventions cardiology at MGM Healthcare in Chennai. He drew attention to this type of hypertension as it’s ‘stubborn.’ It is called resistant hypertension (RHTN)

What is resistant hypertension?

As per the cardiologist, resistant hypertension is more than ‘regular high blood pressure.’ If high blood pressure is dangerous, then this type takes it up a notch because it usually doesn’t respond to medications as easily.

“Resistant hypertension (RHTN) is a stubborn form where blood pressure stays high even after taking three or more medications, including a diuretic. What makes it especially concerning is its strong link to stroke, a risk many people are unaware of,” Dr Ezhumalai said.

Further, the condition progresses quietly, as the cardiologist added, “By the time warning signs appear, organs like the heart, kidneys, and brain may already be under strain.”

He cited a study from 2023 which found that, compared to patients without resistant hypertension, those with the condition had a 14 per cent higher risk of stroke.

If this type of hypertension is left unchecked, Dr Ezhumalai alerted that the chances of strokes silently increase. “Patients with RHTN are more likely to experience strokes, often without any obvious warning.” Other than stroke, he added, this hypertension also raises the risk of organ damage.

“About 10% of people with high blood pressure may have RHTN. In India, millions may be at risk without realising it, because the condition often shows no symptoms until serious complications occur,” he said, adding that the lack of early warning signs makes consistent monitoring essential.

What are the warning signs?

“RHTN is usually silent. Headaches, dizziness, or nosebleeds may occur only in severe cases. Most damage to the heart, brain, and kidneys happens quietly over time,” the cardiologist described some of the signs.

Management

Resistant Hypertension can be managed with the help of lifestyle adjustments and medical care. Here are 4 key steps Dr Ezhumalai recommended for managing resistant hypertension:

1. Regular monitoring is essential: Check your blood pressure at home and consider 24-hour ambulatory BP monitoring (ABPM) to detect hidden spikes or nocturnal hypertension, both key risk factors for stroke.
2. Diet: Even stubborn blood pressure can respond to lifestyle changes. Following a DASH diet, rich in fruits, vegetables, whole grains, lean proteins, and low-fat dairy, while reducing salt intake, can help lower blood pressure.
3. Exercise: Regular physical activity, such as brisk walking, swimming, or cycling, also contributes to better control.
4. Stress management and quality sleep: Managing stress and getting adequate sleep play an important role, as both help reduce strain on the heart and brain and support overall cardiovascular health.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.