Patient case (clinical description): A 67-year-old woman comes to the clinic due to recent episode of choking, dysphagia, and cough.  Her other medical problems include hypertension, dyslipidemia, and osteoarthritis.  She does not smoke or use alcohol. She lives with her husband and she is able to do her own daily activities. She used to teach elementary school. Blood pressure is 135/80 mm Hg.  The patient's breath smells bad. Other physical examinations are normal.  A barium swallow study reveals an abnormality in the upper esophagus with an outpouching at the junction of the lower part of the throat and the upper portion of the esophagus.

Patient's own account: I'm a 67-year-old lady, and I went to the clinic due to nonstop choking, difficulty swallowing, and coughing. I also suffer from hypertension, cholesterol, and osteoarthritis. I do not smoke or drink alcohol. I live with my husband, and we are independent retired elementary school teachers. During the exam, my blood pressure was 135/80 mm Hg. The doctor told me I had a smelly breath. How embarrassing! The rest of my physical exam was normal. I did a barium swallow test, which is an X-ray of my throat, which revealed a problem in the upper part of my esophagus, where there's a small pouch or bulge at the spot where my throat meets the esophagus.

Clinical trial: Lifestyle Interventions in Treatment-Resistant Hypertension

Eligibility criteria:
Inclusion Criteria:

          -  Documented resistant hypertension (RH). In the absence of a specific RH diagnosis,
             individuals being treated for two or more weeks with 3 antihypertensive medications of
             different classes, including a diuretic if tolerated, with clinic SBP ≥ 130 mm Hg or
             DBP ≥ 80 mm Hg, will be eligible. Individuals being treated with 4 or more
             antihypertensive medications, including a diuretic if tolerated, with SBP ≥ 120 or DBP
             ≥ 80 mm Hg will also be eligible.

          -  Adherent to prescribed medications

          -  Overweight (BMI ≥ 25 kg/m2)

          -  Sedentary

          -  Willing to be randomized to one of the 2 treatment groups and able to fully
             participate in intervention

          -  Informed consent

        Exclusion Criteria:

          -  Secondary HTN, non-adherence to anti-HTN medications

          -  Severe CKD (eGFR <40 ml/min/1.73m2)

          -  Severe ischemic heart disease (CCS Class 3 or 4 angina or evidence of ischemia at <85%
             heart rate reserve on treadmill testing)

          -  Severe heart failure (NYHA association Class 3 or 4), high grade arrhythmias, severe
             valvular heart disease

          -  Severe asthma or chronic obstructive lung disease

          -  Diabetes requiring insulin

          -  Musculoskeletal or neurologic problems that would preclude participation in aerobic
             exercise training

          -  Major psychiatric disorder, a history of drug abuse, alcohol consumption >14
             drinks/week

          -  Life-limiting comorbid medical condition such as cancer

          -  Prior gastric bypass surgery

          -  Currently pregnant

          -  Cognitively impaired
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 35 Years old.


Eligibility (NLI label): Contradiction