How is resistant hypertension diagnosed?

To make a diagnosis of resistant hypertension, your healthcare provider may:

Get a detailed history and physical exam. In a detailed history your provider may ask when your high blood pressure began and how long it’s been going on; current drugs you take (including herbal medications) and if you take them as prescribed; and questions about possible secondary causes of your uncontrolled hypertension.

The physical exam will look for abnormal changes in the eye (a condition called hypertensive retinopathy), and abnormal sounds called bruits (vascular murmur) over some major arteries. These bruits may signal abnormal deposits of fatty tissue, also called plaques, in these blood vessels.

Order laboratory tests. These may include a urine test for protein or albumin; blood tests for glucose, electrolytes such as sodium and potassium and the blood creatinine level. A blood test may be done for adrenal hormones, to screen for possible disease in the adrenal glands. In addition, since hypothyroidism can contribute to high blood pressure, you may also be tested for thyroid disease.

Order imaging studies. X-rays, ultrasound and CT scans and other tests may be ordered depending on other conditions your provider may need to rule out. For example, imaging tests of the kidneys may be done to rule out abnormal blockage of the arteries to the kidneys (renal artery stenosis).

Order tests for sleeping disorders. You may be asked to undergo a sleep study to check for sleep apnea.

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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