Resistant hypertension is high blood pressure that is difficult to treat. Despite taking blood pressure medications and improving your diet, your blood pressure is stubborn and remains uncontrolled.

The clinical definition of resistant hypertension is blood pressure of 140/90 mmHg or higher while taking three or more blood pressure medications. Resistant hypertension may also be called chronic hypertension, complex hypertension, or unresponsive hypertension.

If you have resistant hypertension, you should take it seriously. Resistant hypertension puts you at a higher risk of heart disease, including heart attack and stroke.

Causes of Resistant Hypertension

There are several different conditions that cause or contribute to resistant hypertension, including the following:

  • Diabetes
  • Obesity
  • Sleep apnea
  • Renal artery stenosis (a narrowing of the arteries that lead to the kidneys)
  • Certain types of cancer
  • Hormone or endocrine dysfunction

Detecting and Diagnosing Resistant Hypertension

Non-invasive cardiologists have special expertise in diagnosing resistant hypertension. Your doctor may ask you to either keep a blood pressure log or wear a 24-hour blood pressure monitor at home. The monitor will record any patterns in your blood pressure and differences between activity and rest and between day and night.

Your doctor will also order tests, like labs and imaging, to rule out other underlying causes of resistant hypertension, such as renal artery stenosis (a narrowing of the arteries that lead to the kidneys), certain types of cancer, and hormone or endocrine dysfunction. In these cases, you may be referred to a different type of doctor to treat these conditions.

Treatment and Management

Treating resistant hypertension requires a combination of approaches, including continued monitoring, more lifestyle changes, new medications and/or increased dose of current medications.

While your doctor adds new treatments, you will need to check your blood pressure with an at-home monitor several times a day. This will help determine if your new treatments are working.

Your doctor will ask you to limit excess salt in your diet and eliminate alcohol. It is also very important not to smoke, as smoking increases your blood pressure.

You will need to eat a heart-healthy diet that includes six or more servings of fruits and vegetables each day. You will also need to eat healthy fatty acids found in un-salted nuts and fish.

Depending on how often you exercise, you may also need to increase your physical activity. Doctors recommend at least 30 minutes a day of moderate exercise, like walking or riding a bike, for most patients.

Medications are an essential part of your treatment plan. Many cases of resistant hypertension occur when patients do not take their blood pressure medicines correctly. It is essential that you take your medications as directed — the correct dose, correct time of day, and correct number of times per day.

You may need to take three to four different medications to control your high blood pressure. Your doctor will adjust your medications, both type and dose, to meet your individual needs. Types of blood pressure medications include the following:

  • Diuretics: These medications rid your body of excess fluid.
  • Calcium channel blockers: These medications widen your blood vessels.
  • ACE inhibitors/angiotensin receptor blockers: These medications relieve stress on the heart’s pumping action.
