What Is Resistant Hypertension?

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What Is Resistant Hypertension?

High blood pressure, also called hypertension, is common in people who have diabetes. Treatments are available for high blood pressure, but if you’re noticing that, despite taking two or more blood pressure medications, eating healthfully, and being faithful with fitting in physical activity, your blood pressure is still above your target, you might have what is called resistant hypertension.

What is resistant hypertension?

The Cleveland Clinic defines resistant hypertension as “a condition where your blood pressure remains high or uncontrolled despite the medications you take to lower it.” In other words, this is high blood pressure that does not respond well to treatment.

Specifically, you might have resistant hypertension if you meet all of these criteria:

  • You take three different blood pressure medications at their maximum doses
  • One of these medications is a diuretic (“water pill”)
  • Your blood pressure remains above your goal (usually 130/80 mmHg)
  • You need four or more medications to control your blood pressure

Resistant hypertension can greatly increase the risk of heart attack, stroke, and kidney failure.

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What are the symptoms of resistant hypertension?

People with this condition may not have any symptoms. This is true, as well, if you have “regular” high blood pressure, and it’s also why high blood pressure is known as the “silent killer.” Checking your blood pressure at home is important to do, especially as you get older. Accurate and inexpensive home blood pressure monitors are available at your drugstore or online.

Symptoms of dangerously high blood pressure (called a hypertensive crisis) include:

  • Chest pain
  • Nosebleed
  • Shortness of breath

Of course, these symptoms can be caused by other conditions, so if they occur, seek medical attention right away.

What causes resistant hypertension?

There can be several reasons for why you might have resistant hypertension, including:

  • Sleep apnea
  • Chronic kidney disease
  • Renal stenosis, which is a buildup of plaque in blood vessels that support the kidneys
  • Obesity
  • Primary aldosteronism (aldosterone is a hormone that helps the body regulate blood pressure)
  • Hyper- or hypothyroidism
  • Cushing’s disease
  • Diabetes
  • Heavy alcohol intake
  • Certain medications, such as NSAIDS (non-steroidal anti-inflammatory drugs), nasal decongestants, birth control pills, some herbal supplements (ginseng, licorice)

These above factors are considered secondary causes of hypertension. However, in the majority of people with resistant hypertension, there is no identifiable cause. This is called primary or essential hypertension.

The “white coat” effect, which occurs when a person’s blood pressure is higher in the doctor’s office than at home, can mimic resistant hypertension, but this does not necessarily mean that a person has resistant hypertension.

How is resistant hypertension diagnosed?

In order to determine if you have resistant hypertension, your health care provider will likely do a physical exam, and review your medical history and the medications that you take, for starters. They may also:

  • Check your blood pressure.
  • Recommend home blood pressure monitoring during the day and 24-hour ambulatory blood pressure monitoring.
  • Check for secondary causes.
  • Perform other tests, if indicated, such as an EKG, chest X-ray, eye exam, urinalysis, and blood work. Imaging tests may be done, for example, to rule out blockages in arteries of the heart or kidneys.
  • Recommend a sleep study to check for sleep apnea.

How is resistant hypertension treated?

The results of the above tests can indicate the need for certain types of treatment, which, in turn, can help with blood pressure control. For example, if thyroid hormone levels are low, you will need treatment for hypothyroidism. Likewise, if you are diagnosed with sleep apnea, treatment for this condition can help treat resistant hypertension.

The American Heart Association shares that lifestyle factors are important in treating this condition, including:

You may need to take several different types of blood pressure medication to help treat resistant hypertension, including ACE inhibitors or ARBs, calcium channel blockers, and/or a diuretic. Taking your blood pressure medication as directed is extremely important, since about 40% of resistant hypertension cases occur because medications aren’t taken correctly. Make sure you understand:

  • When (time of day) to take your medication
  • How often to take your medication
  • How much medication to take

Let your provider know if you have difficulty taking medication due to side effects or forgetting to take them, or if you can’t afford them. They should address these issues with you and find the right treatment plan that works for you.

Want to learn more about high blood pressure? Read “Treating High Blood Pressure” and “Blood Pressure Chart: What Do Your Blood Pressure Readings Mean?”

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter,, and

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