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What Can I Do if My Blood Pressure Isn’t Responding to Medication?

March 30, 2023

Between 10 and 20 percent of people living with hypertension are considered resistant to medication – meaning their high blood pressure isn’t responding to medication.

“Resistant hypertension is when a patient has uncontrolled blood pressure despite taking three medications… or when their blood pressure is under control while on four medications,” says Suhash Patel, DO, a cardiologist with the Heart & Vascular Institute at St. Vincent’s Medical Center.

If you fall into this category, you could be at risk of long-term complications such as stroke or heart issues.

But, can anything be done? Dr. Patel explains what causes resistant hypertension and the options for treatment.

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Secondary hypertension is a contributing factor.

Most individuals with resistant hypertension have underlying conditions that cause secondary hypertension.

These can include:

  • Kidney disease
  • Excess of aldosterone or adrenaline hormones
  • Narrowing of arteries that supply the kidneys
  • Cushing’s syndrome
  • Sleep apnea

> Related: 5 Natural Ways to Lower Your Blood Pressure

But, it’s not just about underlying conditions.

Around 50 percent of those with resistant hypertension have “pseudo-resistance,” which means that outside factors are having an effect. Some examples of factors that may impact blood pressure management include:

  • White coat effect (higher blood pressure at the doctor’s office due to stress or anxiety)
  • Not taking medication as directed
  • Non-optimal dosages or types of blood pressure medication
  • Poor blood pressure technique

“Often, these patients also have external factors such as psychosocial stressors, alcohol or substance abuse, and other prescription or over-the-counter medications that can elevate their blood pressure,” Dr. Patel says.

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How do you treat resistant hypertension?

The good news is that resistant hypertension can be treated and ultimately reversed with guidance from a doctor.

“If the patient has a secondary cause of resistant hypertension we can treat the underlying condition to normalize blood pressure,” Dr. Patel says. “However, for most, it is often about medication compliance, lifestyle changes with diet, exercise, weight loss and controlling psychosocial factors that may play a role.”

What should I do if I think I have resistant hypertension?

Your primary care doctor can determine if you are considered truly resistant. The criteria for diagnosis is:

  • Taking three different blood pressure medications at the maximum tolerated dose
  • One medication is a diuretic
  • Blood pressure remains above goal (130/80)

Your doctor may refer you to a specialized resistant hypertension clinic like one in Fairfield.

“The goal of the clinic is to normalize blood pressure either with medication adjustment, lifestyle changes or addressing and treating a secondary cause,” Dr. Patel says.

Beyond cardiologists, the clinic has nephrologists and endocrinologists to assess your kidneys and hormone levels.

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