What is resistant hypertension?

Resistant hypertension is a condition where your blood pressure remains high or uncontrolled despite the medications you take to lower it. Hypertension (high blood pressure) is a major health issue. But it becomes even more frustrating when you are on multiple medications and don’t see any improvements. People with hard-to-treat, resistant hypertension have a higher risk of stroke, kidney disease and heart failure than people whose high blood pressure is controlled.

If you have resistant hypertension:

  • Your blood pressure stays high (reading of 130/80 mmHg and above) — even if you take three blood pressure-lowering medications including one diuretic (water pill).
  • You are taking four or more medications to control your high blood pressure.

Sometimes an underlying medical condition, or secondary cause, can keep your high blood pressure resistant to medications.

Who is at risk for developing resistant hypertension?

You’re more likely to have resistant hypertension if you:

What are the symptoms of resistant hypertension?

High blood pressure itself rarely causes symptoms, which is why it’s called the “silent killer.” Some people can go years without even realizing they have hypertension. But untreated high blood pressure is potentially dangerous to your health.

You and your healthcare provider should monitor your blood pressure numbers regularly, especially as you get older. You can also measure it at home with a good, inexpensive electronic monitor, available at most drug stores or online.

However, if your blood pressure suddenly gets very high you may experience a hypertensive crisis with headaches, pounding in the chest, dizziness and shortness of breath. A hypertensive crisis needs attention immediately.

What causes resistant hypertension?

Lifestyle and diet

The following can all contribute to the development of both hypertension and resistant hypertension:

  • Obesity.
  • Physical inactivity.
  • A diet high in salt.
  • Heavy alcohol intake.

Drugs and medications

A variety of medications including prescription and over-the-counter drugs, can contribute to poor blood pressure control.

Examples include:

  • Painkiller medications, especially NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen and naproxen.
  • Nasal decongestants.
  • Oral contraceptives (birth control pills).
  • Ginseng, licorice or other herbal products.

Secondary causes

Sometimes treatable secondary causes may be the source of your resistant hypertension. These conditions may be raising your blood pressure.

Examples of such secondary causes include:

  • Primary hyperaldosteronism, an excessive production of certain hormones from the adrenal glands.
  • Renal artery stenosis, a narrowing of the arteries of the kidneys.
  • Chronic kidney disease.
  • Sleep apnea.
  • Less common causes include pheochromocytoma, a tumor in the adrenal gland; aortic narrowing; and Cushing syndrome, an overproduction of some steroid hormones.

Last reviewed by a Cleveland Clinic medical professional on 02/18/2020.

References

  • Carey RM, Calhoun DA, Bakris GL, et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018; 72(5):e53-e90
  • American Heart Association. Resistant Hypertension. Accessed 3/28/2020.
  • American College of Cardiology. Diagnosis and Management of Resistant Hypertension. Accessed 3/28/2020.
  • Yaxley JP, Thambar SV. Resistant hypertension: an approach to management in primary care. J Family Med Prim Care. 2015;4(2):193–199. doi:10.4103/2249-4863.154630
  • Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: Diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008;51:1403-1419.
  • Vongpatanasin W. Resistant hypertension: A review of diagnosis and management. JAMA 2014;311:2216-2224.

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