What is resistant hypertension?

Resistant hypertension is a condition in which blood pressure remains high despite efforts to lower it. Resistant hypertension is defined as follows:

  • High blood pressure (hypertension) that is not at goal even with the use of three medicines, including a diuretic (water pill);
  • Blood pressure that can be controlled only with the use of four or more medications.

Patients with resistant hypertension have a higher risk of strokes and heart attacks than those whose blood pressure can be controlled, or people who do not have high blood pressure.

Who is likely to have resistant hypertension?

People who are more likely to have resistant hypertension include:

  • African-Americans
  • Women
  • People who have diabetes
  • People who are obese

What are the causes of resistant hypertension?

Many patients have higher blood pressure when the measurement is taken in the doctor’s office; this is known as “white coat hypertension.” For this reason, blood pressure readings that are taken at home may be more effective at predicting strokes and heart attacks. Your doctor may ask you to wear a 24-hour blood pressure monitor to record your blood pressure throughout the day and at nighttime.

Other causes of resistant hypertension include:

  • An excess of certain hormones, such as aldosterone
  • A tumor in the adrenal gland known as pheochromocytoma
  • A narrowing of the arteries in the kidney (renal artery stenosis)
  • Pauses in your breathing while you sleep (sleep apnea)

Resistant hypertension may also result from the use of:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen
  • Nasal decongestants and cough and cold remedies
  • Oral contraceptives (birth control pills)
  • Ginseng, licorice, or other herbal products
  • Too much alcohol (more than 2 drinks/day for men and more than 1 drink/day for women)
  • Too much salt on food

Last reviewed by a Cleveland Clinic medical professional on 09/26/2014.


  • 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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