When your blood pressure medication isn’t enough

If your blood pressure has crept up over the years, you likely take one or more drugs to help bring it down. But what happens when medication isn’t enough to control your hypertension?

Although high blood pressure is often treated successfully with medication and lifestyle changes, resistant hypertension is not so easy to address, hypertension specialist Dr. George Thomas said in a report posted on ClevelandClinic.org.

High blood pressure is sometimes known as “the silent killer” — so named because it increases the risk of heart attack and stroke, but often goes unnoticed because of its lack of obvious symptoms. In fact, you may have high blood pressure and not even know it.  But resistant hypertension, just as the name says, is when your high blood pressure is difficult to control even with medication.

“Resistant hypertension is the failure to reach your goal blood pressure when you’re adhering to maximally tolerated doses of an appropriate three-drug regimen that includes a diuretic,” explains Dr. Thomas.

Put another way: If you have high blood pressure, and you’re taking the maximum dose of three different blood pressure medications including a water pill (diuretic), and your blood pressure still isn’t at safe levels, you may have resistant hypertension. And you’ll need to do more to control it.

Diagnosing resistant hypertension isn’t always simple. Getting a consistently accurate reading is key, and sometimes that’s tricky.

There are several reasons why you might get an inaccurate reading. This can happen if:

  • The blood pressure cuff is too small.
  • You haven’t rested long enough before checking blood pressure.
  • You experience “white coat hypertension,” or elevated blood pressure due to anxiety in the doctor’s office.
  • You smoke or have caffeine right before having your blood pressure taken as this can artificially inflate the numbers.

If you rule out all of those factors, and your blood pressure is still elevated, you may have resistant hypertension.

In many cases, it’s a matter of lifestyle. Medication can only do so much to control your blood pressure.

Your doctor likely will explore four possibilities:

  1. If you’re eating a diet that’s high in sodium, smoking, consuming a lot of alcohol, or are overweight and not exercising, your medication may not overcome those behaviors.
  2. Medications you take for other things can contribute to the problem. NSAIDS (non-steroidal anti-inflammatory drugs, such as ibuprofen), oral contraceptives and nasal decongestants all can boost your blood pressure.
  3. There’s also evidence that obstructive sleep apnea can contribute to resistant hypertension. Your doctor may order a sleep study if this is a concern.
  4. If your doctor rules out lifestyle factors and medications, he or she may look for other causes related to hormones or vascular problems.

Managing hypertension isn’t always easy, but making these changes is worth the effort. They will go a long way toward reducing your risk of heart disease and stroke.


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