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Resistant hypertension is high blood pressure that does not improve with medical treatment. To be diagnosed with resistant hypertension, a patient must have tried at least three medications to control it, in addition to making lifestyle adjustments, or have controlled blood pressure only with the assistance of four or more medications. This type of high blood pressure is challenging to treat, but there are treatment options available, and it is important to manage it as effectively as possible, because high blood pressure can cause dangerous medical complications.
When a patient presents with hypertension at the doctor's office, conservative means to control it are often tried first. The patient is evaluated to look for any obvious causes, to see if it is possible to resolve the blood pressure by treating an underlying medical condition or changing an existing medication. The patient may be encouraged to make dietary changes and to exercise more, two measures that can lower blood pressure very effectively in many patients.
If the patient's blood pressure does not drop, medications can be tried to control it. In patients with resistant hypertension, the blood pressure does not decrease despite trying multiple medications and combinations. Some patients can develop secondary symptoms like edema, a buildup of fluid in the extremities, and their hearts and kidneys may be stressed by the consistently high blood pressure. It can take several weeks or months for a doctor to determine that a patient is not responding to hypertension treatment.
Once a patient demonstrably has resistant hypertension, more aggressive means of treatment may be explored. A common reason for resistant hypertension is patient noncompliance, where a patient does not or cannot follow instructions. Adjusting the treatment regimen to make it easier for the patient to follow it may help. Likewise, reviewing the patient's medications and lifestyle very carefully for any signs of conflicts or potential causes of high blood pressure may reveal something that can be changed to bring the blood pressure down.
Additional medications can be tried to bring the blood pressure under control, and the patient's secondary symptoms can also be managed. The timing of medication doses may also be changed. Studies have shown that taking blood pressure medication in the evening before bed can have more of an impact than taking it at other times, and encouraging patients to take medications consistently and at the same time every day can help resolve resistant hypertension.