What Is Resistant High Blood Pressure and How Is It Diagnosed?

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Up to 15 percent of people with high blood pressure have resistant hypertension — blood pressure that exceeds guidelines despite the use of three or more medications, or blood pressure that is within guidelines but requires four or more medications — according to a scientific statement and new hypertension treatment guidelines from the American Heart Association (AHA). Resistant hypertension is more common in African-Americans, men, older adults, people with certain health conditions, including obesity, diabetes, peripheral artery disease (PAD), and sleep apnea.

Diagnosing resistant hypertension can be difficult for several reasons. First and foremost: 50 to 80 percent of people who need blood-pressure lowering medications don’t take them as directed, resulting in poorly controlled blood pressure. In addition, certain over-the-counter and prescription drugs, including nonsteroidal anti-inflammatory drugs (NSAIDs like ibuprofen, aspirin, and naproxen) and oral contraceptives, as well as sleep deprivation, can increase blood pressure.

The AHA statement replaces guidelines for resistant hypertension issued in 2008, and it also recommends:

  • lifestyle changes
  • screening for secondary hypertension (high blood pressure caused by an underlying condition)
  • substituting the diuretics chlorthalidone or indapamide (Thalitone or Lozol, for example) for the more commonly prescribed diuretic hydrochlorothiazide (Microzide)
  • considering the addition of spironolactone (Aldactone, CaroSpir) to the high blood pressure drug regimen for resistant hypertension

Sourced from: American Heart Association