How is resistant hypertension treated?

Your doctor may order tests for kidney disease or the presence of excess hormones that may be leading to high blood pressure. Imaging studies to check the adrenal gland, or for narrowing of arteries, may be needed. You may be asked to undergo a sleep study to check for sleep apnea. In addition, since hypothyroidism can contribute to high blood pressure, you may also be tested for thyroid disease.

Lifestyle changes can help improve blood pressure control. These measures include:

In about 40% of resistant hypertension cases, medications aren’t working because they are not being taken correctly. In order for the drugs to work, they must be taken every day at the correct dose, and the correct number of times per day.

If you have trouble taking your medicine correctly, talk to your doctor. He or she may ask about side effects that may keep you from taking all of your doses. If you have side effects from one drug, your doctor may prescribe another one. You may be switched to medicines that you only need to take once a day. Do not stop taking any medications before speaking to your doctor.

If you have been taking your medication correctly and still have resistant hypertension, your doctor may choose to add another medication. The most common classes of blood pressure medicines are diuretics, calcium channel blockers, and ACE inhibitors/angiotensin receptor blockers (ARBs).

Studies have shown that use of the diuretic chlorthalidone is very effective in treating hypertension. Sometimes a fourth type of medication—an aldosterone antagonist such as spironolactone—may be added to control blood pressure.

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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