Resistant Hypertension - High Blood Pressure That's 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.