OverviewWhat is resistant hypertension?Resistant hypertension is a condition where your blood pressure remains high or uncontrolled despite the medications you take to lower it. Hypertension (high blood pressure) is a major health issue. But it becomes even more frustrating when you are on multiple medications and don’t see any improvements. People with hard-to-treat, resistant hypertension have a higher risk of stroke, kidney disease and heart failure than people whose high blood pressure is controlled. Show
If you have resistant hypertension:
Sometimes an underlying medical condition, or secondary cause, can keep your high blood pressure resistant to medications. Who is at risk for developing resistant hypertension?You’re more likely to have resistant hypertension if you:
Symptoms and CausesWhat are the symptoms of resistant hypertension?High blood pressure itself rarely causes symptoms, which is why it’s called the “silent killer.” Some people can go years without even realizing they have hypertension. But untreated high blood pressure is potentially dangerous to your health. You and your healthcare provider should monitor your blood pressure numbers regularly, especially as you get older. You can also measure it at home with a good, inexpensive electronic monitor, available at most drug stores or online. However, if your blood pressure suddenly gets very high you may experience a hypertensive crisis with headaches, pounding in the chest, dizziness and shortness of breath. A hypertensive crisis needs attention immediately. What causes resistant hypertension?Lifestyle and diet The following can all contribute to the development of both hypertension and resistant hypertension:
Drugs and medications A variety of medications including prescription and over-the-counter drugs, can contribute to poor blood pressure control. Examples include:
Secondary causes Sometimes treatable secondary causes may be the source of your resistant hypertension. These conditions may be raising your blood pressure. Examples of such secondary causes include:
Diagnosis and TestsHow is resistant hypertension diagnosed?To make a diagnosis of resistant hypertension, your healthcare provider may: Get a detailed history and physical exam. In a detailed history your provider may ask when your high blood pressure began and how long it’s been going on; current drugs you take (including herbal medications) and if you take them as prescribed; and questions about possible secondary causes of your uncontrolled hypertension. The physical exam will look for abnormal changes in the eye (a condition called hypertensive retinopathy), and abnormal sounds called bruits (vascular murmur) over some major arteries. These bruits may signal abnormal deposits of fatty tissue, also called plaques, in these blood vessels. Order laboratory tests. These may include a urine test for protein or albumin; blood tests for glucose, electrolytes such as sodium and potassium and the blood creatinine level. A blood test may be done for adrenal hormones, to screen for possible disease in the adrenal glands. In addition, since hypothyroidism can contribute to high blood pressure, you may also be tested for thyroid disease. Order imaging studies. X-rays, ultrasound and CT scans and other tests may be ordered depending on other conditions your provider may need to rule out. For example, imaging tests of the kidneys may be done to rule out abnormal blockage of the arteries to the kidneys (renal artery stenosis). Order tests for sleeping disorders. You may be asked to undergo a sleep study to check for sleep apnea. Management and TreatmentHow is resistant hypertension treated?Your doctor may order tests for kidney disease or the presence of excess hormones that may be leading to high blood pressure. Imaging studies to check the adrenal gland, or for narrowing of arteries, may be needed. You may be asked to undergo a sleep study to check for sleep apnea. In addition, since hypothyroidism can contribute to high blood pressure, you may also be tested for thyroid disease. Lifestyle changes can help improve blood pressure control. These measures include:
In about 40% of resistant hypertension cases, medications aren’t working because they are not being taken correctly. In order for the drugs to work, they must be taken every day at the correct dose, and the correct number of times per day. If you have trouble taking your medicine correctly, talk to your doctor. He or she may ask about side effects that may keep you from taking all of your doses. If you have side effects from one drug, your doctor may prescribe another one. You may be switched to medicines that you only need to take once a day. Do not stop taking any medications before speaking to your doctor. If you have been taking your medication correctly and still have resistant hypertension, your doctor may choose to add another medication. 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. Sometimes a fourth type of medication—an aldosterone antagonist such as spironolactone—may be added to control blood pressure. What is treatment resistant hypertension?Resistant hypertension is defined as a blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes taken at maximally tolerated doses, one of which should be a diuretic (the diuretic should be selected based upon kidney function) [1-5].
What is considered uncontrolled hypertension?§ Uncontrolled hypertension is defined as an average systolic blood pressure ≥140 mmHg or an average diastolic blood pressure ≥90 mmHg, among those with hypertension.
What can cause uncontrolled hypertension?The major causes of uncontrolled hypertension are inadequate therapy, patient noncompliance and inappropriate therapy.
What is meant by resistant 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.
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