Resistant hypertension affects 12% to15% of patients treated for high blood pressure according to a new scientific statement from the American Heart Association. The study was published in the Association's journal Hypertension, provides a comprehensive overview of how to diagnose and treat the condition based on a review of available scientific information.

Patients are diagnosed with resistant hypertension when they need three or more medications to treat high blood pressure but still have blood pressure that exceeds the goal for hypertension.

Resistant Hypertension

Also, patients whose blood pressure achieves target values on four or more different types of blood pressure lowering medication are also considered to have resistant hypertension. Resistant hypertension is more often found among African-Americans, men, older adults and, people who are obese, or those who have diabetes, peripheral artery disease, obstructive sleep apnea or other conditions.

The statement notes that 50% to 80% of people who should be taking blood pressure lowering medications don't take them correctly because the regimen may be expensive and have unwanted side effects, which can result in it poorly controlled blood pressure.

Also, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, aspirin, naproxen and some prescription medications, such as oral contraceptives may also raise blood pressure, so health care providers should ask patients if they are using these medications.

Diagnosis For Resistant Hypertension

Once the physician has confirmed a diagnosis of resistant hypertension, healthcare providers should work with their patients to help them improve their lifestyle. Patients should also aim for healthy body weight and get enough physical activity to help lower blood pressure.

Some people with resistant hypertension may be extremely sensitive to salt in their diet. In one of the studies we reviewed, when salt intake was significantly lowered in people with resistant hypertension, blood pressure promptly went down.

Drinking too much alcohol and tobacco use are also lifestyle factors that affect blood pressure. Once a clear diagnosis of resistant hypertension is made, healthcare providers have a variety of medication regimens to help their patients.

By definition, the patient will already be taking three different classes of antihypertensive drugs, including a long-acting calcium channel blocker (CCB), an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) which interacts with the renin-angiotensin system and a diuretic.

Treating patients for secondary hypertension can often cure them. Secondary hypertension frequently arises from a condition called primary aldosteronism, a disorder of increased aldosterone secretion, which is found in about 20% of patients with resistant hypertension. 

High Blood Pressure Patients

Patients with high blood pressure are more likely to develop cardiovascular diseases such as heart attacks, heart failure, and stroke, and their prognosis deteriorates further if they have resistant hypertension.

The major changes from the 2008 statement are that the criteria for defining resistant hypertension have become more specific, the recognition that sleeps deprivation contributes to lack of blood pressure control, the importance of lifestyle change to prevent and treat resistant hypertension.