September 01, 2019

Resistant hypertension

When blood pressure is hard to treat

At your last visit with your doctor, your blood pressure was high and it has been high for the past few visits. Your doctor has prescribed multiple medications to control your blood pressure, but you still haven't reached your goal and it's all starting to feel a bit overwhelming. You're not sure what will help.

The benefits of treating high blood pressure are well known. Keeping your blood pressure at optimal levels reduces the risk of damage to your blood vessels, which helps to prevent conditions such as stroke, heart attack, coronary artery disease, heart failure and worsening chronic kidney disease.

Yet a substantial number of people have high blood pressure despite being treated for it (resistant hypertension). In technical terms, this means that your blood pressure remains above goal even though you're taking at least three different types of blood pressure drugs at maximum doses, including a diuretic. It's estimated that nearly 1 in 6 American adults treated for high blood pressure has resistant hypertension. There are a number of reasons why, many of which are reversible.

A closer look

For starters, it's important to rule out external factors that can affect your blood pressure readings. About 15% to 30% of people with hypertension have what's called white coat hypertension, which means that their blood pressure increases at the doctor's office but goes back down at home. Your doctor may have you monitor your blood pressure at home for a more accurate estimate of your blood pressure.

It may also be that another condition —...