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hypertension can easily be diagnosed through a simple and non-invasive test, and can be kept under control through medication and lifestyle changes. But there are situations where hypertension is resistant to treatment.

The tricky thing about hypertension is that it usually doesn’t show any symptoms, sometimes not even in its most advanced stages. However, hypertension can easily be diagnosed through a simple and non-invasive test, and can be kept under control through medication and lifestyle changes. But there are situations where hypertension is resistant to treatment.

Resistant hypertension: Diagnosis and management

Hypertension is a condition that leads to significant increases in mortality. Resistant hypertension will normally be diagnosed when a person has elevated blood pressure (which exceeds 140/90 mm Hg) which has proven to be resistant to at least three different medications for treating hypertension. The treatment must have included at least one diuretic, one calcium channel blocker, and one ACE inhibitor.

There are cases where a person could have mere pseudoresistant hypertension, so carefully examining the patient for resistant hypertension is required to make sure that the right form of medical approach is taken.

In order to diagnose pseudoresistant hypertension accurately, doctors need to consider the following:

  • The patient could have white coat hypertension, which is elevated blood pressure caused by the medical exam itself.
  • Patients could also be resistant to the specific medications given to treat hypertension. In this case, doctors can choose to prescribe other medication to try and treat hypertension.
  • Sometimes, external factors can lead to elevated blood pressure during the time of measuring. Otherwise, the patient’s blood pressure is within the normal limits. Misreadings can happen for various reasons: the patient has recently exercised, consumed alcohol, is under a lot of stress, or the blood pressure measuring technique is poor.
  • Patient could also be intolerant to certain hypertensive meds.

Testing a patient’s adherence to medication can be done by taking a urine sample after the meds were taken, in order to determine the drug’s metabolites. Once resistant hypertension has been diagnosed, doctors will add a fourth medication to the line of treatment.

Doctors may choose to perform a series of tests in order to properly diagnose resistant hypertension:

  • Measuring blood pressure through a calibrated monitor for better accuracy.
  • Tests which help identify if the patient is suffering from another medical condition that could lead to secondary hypertension.
  • Tests which can help doctors see if there is any organ damage as a result of elevated blood pressure. These include: electrocardiograms and echocardiograms (for measuring heart size, rhythm, and function), eye exams (which help track potentially damaged blood vessels in the eyes), urine analysis (to see if there is any kidney damage), chest X-rays, and even blood tests (for spotting rare genetic disorders).

Resistant hypertension: Causes

Studies have shown that almost 25 percent of the people who have been diagnosed with resistant hypertension were able to get to the root of the problem. Hypertension can have either essential or secondary causes, and the latter category includes elevated blood pressure that has an identifiable source.

Secondary hypertension can be kept under control as long as the problem that caused it is the first one to be treated. Primary (or essential) hypertension doesn’t have a medical cause, so the treatment is pretty generic and will focus on lifestyle improvements and high blood pressure medication.

Secondary resistant hypertension can be caused by any of the following structural disorders:

  • Sleep apnea is a common sleep disorder characterized by shortness of breath that can last for a few seconds and can lead to elevated blood pressure.
  • Kidney hypertension, also known as renal artery stenosis, can cause the blood supply artery to the kidney to become narrow.
  • Similar to the condition described above, there could also be a narrowing in the aorta that transports blood from the heart to other body parts.

Hormonal disorders have also been linked to severe and resistant hypertension:

  • Cushing’s disease, which is caused by a pituitary gland tumor, amplifying the release of a hormone called cortisol.
  • Primary aldosteronism, which is a condition that leads to elevated blood pressure as a result of an adrenal gland disorder.
  • Both hypothyroidism and hyperthyroidism can raise blood pressure.

Lifestyle factors that contribute to resistant hypertension

Since resistant hypertension is a severe form of high blood pressure, it’s important to consider making the lifestyle changes that are often associated with this kind of medical problem.

  • Obesity is a condition often linked with resistant hypertension. A lot of complexity lies behind resistant hypertension induced by obesity, but some of the mechanisms include elevated nervous system activity and impaired sodium excretion.
  • A high intake of salt can also influence resistant hypertension in two ways: either by elevating the blood pressure directly, or by counteracting the effects of antihypertensive medication.
  • Alcohol and hypertension are strongly linked to one another, as the former can greatly increase the odds of elevated blood pressure.

Naturally, the best thing to do is to avoid consuming alcohol, large quantities of salt, and lose a few pounds if you are overweight. These recommendations aren’t just for people who suffer from resistant hypertension, but also for those who have elevated blood pressure.

Medical treatment for resistant hypertension is mandatory, but the doctors will have to check for secondary hypertension causes first. Note that medication can be different from one patient to another, and finding the correct dosage can take time.

It’s best to work with a doctor who is already aware of the evolution of your high blood pressure, because they know what type of medication you respond to, as well as which type of treatment to avoid.


Keeping blood pressure under control is in direct correlation with your lifestyle habits. Assuming that you can take medication to keep blood pressure under control while not ceasing bad dietary habits and desisting of a sedentary lifestyle is a wrong assumption. Even if you’re taking the most efficient resistant hypertension medication, it’s still very important to adjust your diet accordingly, and exercise to avoid obesity.

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