Resistant High Blood Pressure

What is resistant high blood pressure?

Resistant high blood pressure is hypertension that does not respond well to aggressive medical treatment. 

Hypertension  (high blood pressure) is considered resistant as failure to achieve goal blood pressure while receiving a 3 drug regimen at optimal doses that includes a diuretic.

What causes resistant hypertension?

The following can all contribute to the development of resistant hypertension:

Lifestyle and diet

  • Obesity.
  • Physical inactivity.
  • A diet high in salt.
  • Heavy alcohol intake.

Drugs and medications

A variety of medications including prescription and over-the-counter drugs, can contribute to poor blood pressure control.

Examples include:

  • Painkiller medications, especially non-steroidal anti-inflammatory drugs, like ibuprofen and naproxen.
  • Nasal decongestants.
  • Oral contraceptives.
  • Ginseng, licorice or other herbal products.

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:

  • Primary hyperaldosteronism, an excessive production of certain hormones from the adrenal glands.
  • Renal artery stenosis, a narrowing of the arteries of the kidneys.
  • Chronic kidney disease.
  • Sleep apnea.
  • Less common causes include pheochromocytoma, a tumor in the adrenal gland; aortic narrowing; and Cushing syndrome, an overproduction of some steroid hormones.

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Resistant hypertension, diagnosis

To make a diagnosis of resistant hypertension, your doctor should:

  • Obtain a detailed history and physical examination. The history will indicate when your hypertension began and how long you have had it; the drugs you are currently taking (including herbal medications) and whether you are taking them as prescribed; and possible secondary causes of your uncontrolled hypertension.
  • Perform a physical exam will look for abnormal changes in the eye (a condition called hypertensive retinopathy), and abnormal sounds called murmurs (vascular murmur) over some major arteries. 
  • Order laboratory tests. They may include a urinalysis for protein or albumin; blood tests for glucose, electrolytes such as sodium and potassium, and blood creatinine level. A blood test for adrenal hormones may be done to detect possible disease in the adrenal glands. In addition, you may also be tested for thyroid disease.
  • Order imaging studies. X-rays, ultrasounds and CT scans may be ordered, as well as other tests, depending on what other conditions the doctor needs to rule out. For example, imaging tests of the kidneys may be done to rule out abnormal blockage of the arteries leading to the kidneys (renal artery stenosis).
  • Order tests to screen for sleep disorders.

What can you do for resistant hypertension?

Here is a reminder of lifestyle changes that can help control high blood pressure:

  • Choose heart-healthy foods. Consider the Dietary Approaches to Stop Hypertension (DASH) diet, which focuses on fruits, vegetables, whole grains, poultry, fish, and low-fat dairy products. Eat more potassium-rich fruits and vegetables. Potassium helps lower blood pressure. 
  • Reduce the level of salt in your diet. Try to limit your sodium intake to less than 2,300 milligrams per day. The ideal for most adults is 1500 milligrams of sodium per day or less.
  • Try not to eat processed and restaurant-prepared foods. These foods can be loaded with sodium, which raises blood pressure.
  • Lost weight. Losing even a little weight can lower blood pressure.
  • Get more active. Regular exercise lowers blood pressure and helps you lose weight and fight stress.
  • Learn to react to stress. Stress can lead us to act in a harmful way, which can make blood pressure worse. Try to manage stress in a healthy way, for example through meditation or deep breathing exercises.
  • Go easy on alcohol. Avoid or reduce alcohol consumption. Alcohol can increase blood pressure.
  • Stop smoking. Tobacco causes an increase in blood pressure and plaques that quickly build up in the arteries.
  • Check over-the-counter medications.

What is the cause of resistant hypertension?

Common factors that can lead to high blood pressure include: 

A diet high in salt, fat, and/or cholesterol. Chronic conditions such as kidney and hormone problems, diabetes, and high cholesterol. Family history, especially if your parents or other close relatives have high blood pressure.

Does high resistance cause high blood pressure?

In the arterial system, as resistance increases, blood pressure increases and flow decreases. In the venous system, constriction increases blood pressure as it does in arteries; the increasing pressure helps to return blood to the heart.

Narrow blood vessels, also known as arteries, create more resistance for blood flow. The narrower your arteries are, the more resistance there is, and the higher your blood pressure will be.

Resistant hypertension treatment.

Treatment options for resistant hypertension or pseudo-resistant hypertension (described below) depend on your underlying conditions and how well you tolerate various medications. Treatments include:

  •  Addressing any conditions that may have caused hypertension.
  •  Making lifestyle changes
  •  Adjusting medications to find your optimal type and dosage
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