If your blood pressure has crept up over the years, you likely take one or more drugs to help bring it down. But what happens when medication isn’t enough to control your hypertension?
 
Although high blood pressure is often treated successfully with medication and lifestyle changes, resistant hypertension is not so easy to address. Kidney medicine and hypertension specialist George Thomas, MD, Cleveland Clinic, Ohio, helps unpack this common cardiovascular disease.
 
High blood pressure is sometimes known as “the silent killer” — so named because it increases the risk of heart attack and stroke, but often goes unnoticed because of its lack of obvious symptoms. In fact, you may have high blood pressure and not even know it.
 
But resistant hypertension, just as the name says, is when your high blood pressure is difficult to control even with medication.
 
“Resistant hypertension is the failure to reach your goal blood pressure when you’re adhering to maximally tolerated doses of an appropriate three-drug regimen that includes a diuretic,” explains Dr. Thomas.
 
Put another way: If you have high blood pressure, and you’re taking the maximum dose of three different blood pressure medications including a water pill (diuretic), and your blood pressure still isn’t at safe levels, you may have resistant hypertension. And you’ll need to do more to control it.
 
Diagnosing resistant hypertension isn’t always simple. Getting a consistently accurate reading is key, and Dr. Thomas says, sometimes that’s tricky.
 
There are several reasons why you might get an inaccurate reading; the blood pressure cuff is too small, you haven’t rested long enough before checking blood pressure, you experience “white coat hypertension,” or elevated blood pressure due to anxiety in the doctor’s office, you smoke or have caffeine right before having your blood pressure taken as this can artificially inflate the numbers.
 
If you rule out all of those factors, and your blood pressure is still elevated, your may have resistant hypertension.
 
In many cases, it’s a matter of lifestyle, Dr. Thomas says. Medication can only do so much to control your blood pressure.
 
If you’re eating a diet that’s high in sodium, smoking, consuming a lot of alcohol, or are overweight and not exercising, your medication may not overcome those behaviors.
 
Medications you take for other things can contribute to the problem. NSAIDS (non-steroidal anti-inflammatory drugs, such as ibuprofen), oral contraceptives and nasal decongestants all can boost your blood pressure, Dr. Thomas says.
 
“Be sure to bring all of your pill bottles, including over-the-counter medications or herbal supplements or vitamins, to your medical appointments,” he says.
 
There’s also evidence that obstructive sleep apnea can contribute to resistant hypertension. Your doctor may order a sleep study if this is a concern.
 
If your doctor rules out lifestyle factors and medications, they may look for other causes related to hormones or vascular problems.
 
Dr. Thomas offers eight tips for managing hypertension. If you do these things, you’ll know you’re doing all you can to help:
 
Make sure you’re taking your hypertension medication correctly and at the scheduled time.
 
If your medication is causing unpleasant side effects, talk to your doctor about alternatives — don’t just stop taking it.
 
Follow a low-sodium diet (less than 2.3 grams per day).
 
Follow the DASH diet, which includes lots of fruits, vegetables, whole grains and lean protein.
 
Exercise regularly — but talk to your doctor first if it’s been awhile since you were physically active. Easing into an exercise program slowly can be your best bet.
 
Limit the amount of processed foods you eat — they’re usually high in sodium.
 
Limit your alcohol intake.
 
Learn to check your blood pressure at home. Ask your doctor to help you create a monitoring schedule. Log the results and bring them to your doctor’s appointments. Have your blood pressure machine checked for accuracy at least once a year.
 
Managing hypertension isn’t always easy, but making these changes is worth the effort. They will go a long way toward reducing your risk of heart disease and stroke.
 
About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. Cleveland Clinic is consistently recognized in the U.S. and throughout the world for its expertise and care. Among Cleveland Clinic’s 82,600 employees worldwide are more than 5,786 salaried physicians and researchers, and 20,700 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,728-bed health system that includes a 173-acre main campus near downtown Cleveland, 23 hospitals, 280 outpatient facilities, including locations in northeast Ohio; Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2024, there were 15.7 million outpatient encounters, 333,000 hospital admissions and observations, and 320,000 surgeries and procedures throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 112 countries. Visit us at clevelandclinic.org. Follow us at x.com/CleClinicNews. News and resources are available at newsroom.clevelandclinic.org.