What is Resistant high blood pressure
High blood pressure (
Hypertension ) is blood pressure that does not show any response to is called as resistance
BP. Particularly, resistant high blood pressure ( Hypertension ) is defined as blood pressure that
remains elevated above treatment goals inspite of taking maximum three drugs that includes also a
diuretic (Drugs for urine excretion). As it is difficult to treat few cases of high blood pressure
( Hypertension ), and may require a combination of multiple drugs before control is established,
high blood pressure ( Hypertension ) cannot be called resistant until this three-drug combination
has been tried.
Diagnosis of Resistant high blood pressure (
Resistant high blood pressure (
Hypertension ) is diagnosed when the blood pressure continues to be elevated despite trying
combination therapy with three drugs. The standard guidelines state that:
blood pressure measurement process must be used
* The size of the blood pressure cuff should be
double checked for accuracy
* The blood pressure readings must be recorded on
two separate occasions
Blood pressure should be taken
in sitting and lying position.
Causes Of Resistant high blood pressure (
There are many factors that can
cause resistant high blood pressure ( Hypertension ), and proper medical testing is required to
investigate each of these potential causes. The three most common causes of resistant high blood
pressure ( Hypertension ) are:
* Patient is
not showing compliance with treatment, i.e not taking medicine regularly.
* Secondary high blood pressure ( Hypertension )
(Usually from overactive adrenal glands or pheochromocytoma)
* Fluid retention (usually expansion from kidney
Additionally, it is important
to make sure that what appears to be resistant high blood pressure ( Hypertension ) isn’t
actually pseudohigh blood pressure ( Hypertension ) or white coat syndrome high blood pressure (
The most common cause of
resistant high blood pressure ( Hypertension ), and the most difficult to treat, is what medical
researchers commonly refer to as "patient noncompliance." The term "patient noncompliance"
refers to situations where patients are not adherent to the prescribed medicines, but is not
meant to imply the patient is always to blame. To the contrary, most cases of "noncompliance"
actually indicate that circumstances not in the patient's control have made following the
recommended therapy either impractical or intolerable.
Patients are sometimes placed
in instances where the recommended drug is very expensive, or the pharmacy shop is very far
away, or doctor appointments are difficult to keep. More commonly, prescribed medications may
have side effects, like dry cough headache or upset stomach or swelling of feet, of sufficient
strength that the patient will stop taking the prescribed medicine to avoid suffering them. When
side effects occur, the doctor usually changes to a drug that is better tolerated. But what
happens if you've tried all the different medicines and the only one that works is the one that
gives you the worst upset stomach? Clearly, situations like this require a great deal of
thoughtful problem solving.
Treatment of Resistant high blood pressure (
Because resistant high blood
pressure ( Hypertension ) is usually the result of some underlying cause, treatment focuses on
correcting this underlying cause. For example, in cases where the resistant high blood pressure
( Hypertension ) is caused by patient noncompliance, doctors will work with the patient to
determine the root issue of the noncompliance and to remove it. In situations where the body
fluid balance is abnormal, usually as a result of kidney disease, measures such as dialysis
might be necessary. If a hormone imbalance is the cause of the resistant high blood pressure (
Hypertension ), then treatment efforts are focused on correcting the patient’s hormone profile
or surgery for adrenals.