Resistant hypertension is high blood pressure that does not respond well to aggressive medical treatment. Hypertension is considered resistant when all of the following are true: Show
Resistant hypertension substantially increases the risk of heart attack, stroke and kidney failure. What You Need to Know
What is hypertension (high blood pressure)?Blood pressure is the force of blood pushing against the artery walls. The force is generated by each heartbeat as blood is pumped from the heart into the blood vessels. The size, tone and elasticity of the arteries walls also affect blood pressure. The kidneys regulate blood pressure as well by regulating the amount of fluid and salt in the body. Hypertension is defined when the average arterial blood pressure during a normal day is 130/80 mmHg or higher. Hypertension progressively damages the walls of large arteries (aorta, carotids) as well as smaller ones (cerebral, coronary, renal, retinal) and makes the heart work harder to get blood pumped through the body. What are the symptoms of resistant hypertension?You can have hypertension without having any symptoms. The best way to know if you have high blood pressure is to have your blood pressure checked by a health care provider. However, symptoms may be felt when blood pressure first rises or during a hypertensive crisis, when levels are extremely high. These symptoms may include headaches, shortness of breath, chest pain and nosebleeds. Dizziness is usually not a symptom of high blood pressure. In fact, dizziness can sometimes be a symptom of low blood pressure. Frequent or unexplained dizziness may be a warning sign of a serious condition and should be addressed by your physician. What are the risks of resistant hypertension?Over time, uncontrolled hypertension damages the arteries, contributing to their stiffening. As the arteries become narrower and less flexible, the heart has to work harder to move blood through the body. Uncontrolled high blood pressure can lead to stroke, heart attack, heart failure and other heart conditions; cause damage to your kidneys, memory and vision; and contribute to erectile dysfunction. What causes resistant hypertension?Underlying Medical CausesIn about 25 percent (1 out of 4) of people with resistant hypertension, there’s an identifiable, or secondary, cause. People whose blood pressure is raised by a medical condition are said to have secondary hypertension. Secondary hypertension will be very hard to control until those conditions are addressed. The more resistant the hypertension, the more likely there is to be a secondary cause. Some common secondary causes of hypertension include: Structural Disorders
Hormonal Disorders
Unknown TriggersIn the other 75 percent of people with resistant hypertension, there is no known medical cause. These people are said to have primary or essential hypertension, and their treatment will focus on medication and lifestyle management. How is resistant hypertension diagnosed?
How is resistant hypertension treated?Treatment options for resistant hypertension or pseudo-resistant hypertension (described below) depend on your underlying conditions and how well you tolerate various medications. Treatments include:
What is pseudo-resistant hypertension?Pseudo-resistant (seemingly resistant) hypertension is high blood pressure that seems to be resistant to treatment, but other factors are actually interfering with proper treatment or measurement. Specifically:
Pseudo-resistant hypertension is also very important to diagnose as true resistant hypertension, because both conditions raise your risk of heart attack and stroke. Wrong Medication or Wrong DoseFor each person there’s an ideal combination of medications and dosages that would best control their hypertension. Some people haven’t yet received that ideal combination. It’s important to work with a doctor who is familiar with the range of medications and who knows what works best for each individual. Medicines and SupplementsMany medications and supplements raise blood pressure. Examples include various pain medications, antidepressants, decongestants, aspirin at high doses and birth control pills. Stimulants — from caffeine and ADHD medications to cigarettes — as well as recreational drugs and excessive alcohol can also raise blood pressure. So can many “natural” or “herbal” supplements, as well as licorice-containing candies or drinks. It’s important to give your doctor the full picture of the medicines and supplements you take, whether you take them every day or just once in a while. Lifestyle FactorsYour lifestyle can make high blood pressure hard to control or may have caused it in the first place. Taking blood pressure medications without changing your habits means your medicine is lowering your blood pressure while your actions raise it back up. Such actions may include:
White-Coat EffectMany people have higher blood pressure in the doctor’s office than they have during their regular day. If your doctor suspects white-coat effect, you may need to wear a small, portable, 24-hour blood pressure monitor to see what your pressure looks like over time during your daily activities, or measure or BP with an automated device at home. Stiffening of the ArteriesSome physicians consider the most authentic form of pseudo-resistant hypertension to be caused by stiffened brachial (arm) arteries that prevent the blood pressure cuff from obtaining a true reading. If your doctor suspects this form of pseudo-resistant hypertension, they might consider other ways to measure your blood pressure. Inadequate Measurement TechniqueThough it sounds simple, blood pressure can be measured incorrectly, and home blood pressure devices may not be properly calibrated. Your health care provider must take several factors into consideration, such as the size of your arm and your body’s position during measurement. What happens if you accidentally take too much blood pressure medication?Overdose symptoms may include slow or uneven heartbeats, shortness of breath, bluish-colored fingernails, dizziness, weakness, or fainting. Your doctor may want you to monitor your blood pressure closely for a time period. He/She may also want to hold your medication until you are regulated.
Can you be on 3 blood pressure medication?People taking one blood pressure medication may reach their blood pressure goals more effectively if they instead take lower doses of three medications. That's according to a new study in Journal of the American Medical Association (JAMA) .
How many BP pills is too many?However, taking too many prescription medications can be risky. Taking more than five medications is called polypharmacy. The risk of harmful effects, drug interactions and hospitalizations increase when you take more medications.
What happens if you accidentally take your medicine twice?Why is double dosing dangerous? Double dosing can temporarily boost the amount of medication in a patient's system, causing an increase in both symptoms and side effects. This is especially dangerous if the patient is taking multiple medications.
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