Descriptive Study of Non-Pharmacological Strategies Actually Used by Patients with Resistant Hypertension in Daily Life

Abstract

Background: Resistant hypertension remains a major clinical challenge because many patients continue to have uncontrolled blood pressure despite multidrug therapy, and little is known about how they use non-pharmacological and complementary strategies in routine life. Objective: To document the types, frequency, and self-perceived effectiveness of lifestyle and complementary non-pharmacological strategies used by adults with resistant hypertension in an urban Pakistani setting. Methods: A descriptive cross-sectional study was conducted over four months in the Islamabad–Rawalpindi region among 72 adults aged 30-70 years with resistant hypertension. Participants were recruited from outpatient clinics, community pharmacies, and patient support settings. Data were collected through face-to-face interviews using a structured questionnaire assessing dietary practices, physical activity, sleep hygiene, herbal therapies, and relaxation or meditation practices. Self-perceived effectiveness was rated on a 5-point Likert scale, and recent blood pressure readings were extracted from patient-held records. Continuous and categorical data were summarized descriptively, and correlations and group comparisons were examined using Pearson correlation and independent-samples t-tests. Results: DASH-style dietary modification was the most commonly used strategy (61.1%), while relaxation or meditation had the highest mean perceived effectiveness score (3.9 ± 0.8). The number of strategies used was positively correlated with overall perceived effectiveness (r = 0.34, p = 0.004), and physical activity was inversely correlated with systolic blood pressure (r = -0.29, p = 0.017). Physically active participants reported higher effectiveness scores than inactive participants (3.8 ± 0.7 vs 3.2 ± 0.9; p = 0.012). Conclusion: Adults with resistant hypertension commonly adopt multiple self-management strategies beyond medication, with relaxation-based approaches and physical activity showing particularly favorable perceived benefit. Integrating patient-reported lifestyle and complementary practices into routine care may support more patient-centered hypertension management.