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Posted on Thu, Dec 13, 2012 : 5 a.m.

Review the best ways to control resistant hypertension

By Ask Dr. K


I've made lifestyle changes and take three blood pressure medications, but my blood pressure still isn't where my doctor wants it to be. What else can I do?


Sometimes high blood pressure (hypertension) doesn't respond to lifestyle changes and medications. This is called resistant hypertension. It is blood pressure that lingers above target levels despite the use of three medications.

And controlling this matters. Heart disease, for example, is much more common in people with resistant hypertension than in people with controlled blood pressure.

One factor that may be contributing to your resistant hypertension is sleep apnea. In this condition, there are pauses in your breathing while you sleep. If you do have sleep apnea, a type of drug called an aldosterone blocker may help.

Some additional steps you can take:

-- Know your true blood pressure. Check your blood pressure at home a few times a day. Home blood pressure machines are very accurate these days; they're also easy to use and relatively inexpensive. Home measurements are helpful because sometimes people have normal blood pressures except when they come to their doctor's office. It's called "white-coat hypertension." Believe it or not, it even happens with my patients.

-- Optimize your medications. You're probably already taking a thiazide diuretic; most people with high blood pressure should be. Many types of drugs can be added to the diuretic. Some people respond better to certain drug types than others. The time of day you take your medications may make a difference. So might taking one long-acting drug versus several short-acting medications.

-- Beware other pills and potions. Some drugs and supplements can boost blood pressure. Ask your doctor if anything you are taking may be having this effect.

-- Get a checkup. In particular, get checked for conditions that contribute to resistant hypertension, such as several adrenal gland diseases, silent kidney disease and sleep apnea.

-- Shake the salt habit. People with resistant hypertension may be especially sensitive to the pressure-boosting effect of sodium. Keep your daily intake of sodium under 1,500 milligrams (about 2/3 teaspoon of salt).

-- Stick with the standards:


*weight control

*eating more fruits and vegetables

*no smoking

*alcohol in moderation, if at all

*stress-relieving activities

A personal anecdote: I have mild high blood pressure that has been easily controlled with medicines for many years. Several months ago, my blood pressure started to go up. None of the conditions that can cause resistant hypertension turned up when I was tested. Increasing the doses of my medicines didn't drop the pressures.

The only thing that was different was I had gained about four pounds on a vacation that was short on exercise and long on eating. When I lost 8 pounds over the next three weeks, my blood pressure dropped to normal.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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