Resistant Hypertension: The High Blood Pressure that is so Hard to Treat

What happens when you hit a high blood pressure plateau?

You’ve made lifestyle changes. You’re taking a diuretic and at least two other blood pressure medicines. But your blood pressure still isn’t budging. This is called resistant hypertension. Simply put, it means that your high blood pressure (HBP or hypertension) is hard to treat and may also have an underlying (secondary) cause.

Possible causes of resistant hypertension

Resistant hypertension may have one or more other underlying medical conditions. In addition to treating resistant hypertension with medications, doctors typically investigate secondary causes (contributing factors), such as:

Abnormalities in the hormones that control blood pressure.
The accumulation of artery-clogging plaque in blood vessels that nourish the kidneys, a condition called renal artery stenosis.
Sleep problems, such as the breath-holding type of snoring known as obstructive sleep apnea.
Obesity or heavy intake of alcohol or other substances that can interfere with blood pressure.

Monitoring and treatment of resistant hypertension

Reining in blood pressure levels begins with the basics, such as understanding your pressure patterns. Sometimes that means wearing a pager-sized automatic blood pressure recorder for 24 hours or checking pressure with an at-home monitor several times a day. Treatment also usually involves a change or addition of medications and investigation of secondary causes – along with key lifestyle changes, including:

Eating a well-balanced, low-salt diet
Limiting alcohol
Enjoying regular physical activity
Maintaining a healthy weight
Managing stress
Taking your medications properly. People with resistant hypertension should take the right medications, in the right doses, at the right time. DO NOT take medications or supplements that can boost blood pressure, such as diet pills and stimulants, cyclosporine, natural licorice, ephedra and painkillers and non-steroidal anti-inflammatory agents (NSAIDs), such as ibuprofen and celecoxib.

Frequently Asked Questions about Resistant Hypertension : What causes resistant hypertension?

Possible causes of resistant hypertension The accumulation of artery-clogging plaque in blood vessels that nourish the kidneys, a condition called renal artery stenosis. Sleep problems, such as the breath-holding type of snoring known as obstructive sleep apnea.

The most common classes of blood pressure medicines are diuretics, calcium channel blockers, and ACE inhibitors/angiotensin receptor blockers (ARBs). Studies have shown that use of the diuretic chlorthalidone is very effective in treating hypertension.

Resistant hypertension is high blood pressure that does not respond well to aggressive medical treatment. Hypertension is considered resistant when all of the following are true: Someone is taking three* different blood pressure medications at their maximally tolerated doses.

As older age and obesity are 2 of the strongest risk factors for uncontrolled hypertension, the incidence of resistant hypertension will likely increase as the population becomes more elderly and heavier.

Resistant hypertension is a major cause of stroke and can be overcome. Measures that can markedly improve blood pressure control include sodium restriction in combination with a diet similar to the Cretan Mediterranean diet, and physiologically individualized therapy based on renin or aldosterone phenotyping.