More about Resistant Hypertension Treatment - when your high blood pressure just won’t budge!

Some types of HBP resist treatment

There are some unlucky people who have been diagnosed with High Blood Pressure (HBP) and who do everything within their power to treat their hypertension and nothing seems to work.  They go through the gamut of life-style changes, like changing their diet, adding exercise and movement to their daily routines, taking up yoga or meditation to help manage stress, and even going on prescription medications…. and yet their blood pressure readings remain stubbornly high.

It seems like they have hit the dreaded High Blood Pressure Plateau and cannot move any further.  How frustrating!

Most of us with hypertension issues are able to make changes in our lives which will usually result in better BP management.  So why does this lack of success occur in a small percentage of those people dealing with high blood pressure?

Today I am going to take a look at some of the possible causes of what is know in medical circles as RESISTANT HYPERTENSION

Resistant Hypertension (RH) - the Why?

Initial investigation into this $64 million question seems to suggest that even the experts are not really sure why some people develop this type of blood pressure which is just so reluctant to respond to any treatment interventions whatsoever.

However the experts do make a distinction between this Resistant Hypertension and the form of Hypertension which on the surface will not respond to treatments - so also seems resistant - but which is actually the consequence of some underlying health process or cause.

This latter kind of high blood pressure is called SECONDARY HYPERTENSION, and later in the article I will look at possible causes for this particular type of hypertension which also resists treatment until the underlying cause is pegged and treated.

How is Resistant Hypertension Diagnosed?

According to a Mayo Clinic Article:

Hypertension (high blood pressure) is considered resistant when a person is taking a diuretic plus two other blood pressure medications, and their blood pressure is still too high.

That is then the official clinical definition!

Usually one treatment approach to RH is to change blood pressure medications to see if introducing a different medication will make any difference. For example a different class of medications may be looked at such as a Beta Blocker or an ACE inhibitor.  And when all this has been tried, and yet nothing is improving, then the Doctor or the Specialist need to probe deeper to try and find out the cause.

And this is when they will start to consider possible underlying conditions which could be the reason that the blood pressure remains elevated despite everything which has been tried to bring it down.

Resistant Hypertension Causes

At this point it becomes a process of elimination, as there are a number of underlying health concerns which can come into play here.  These are the causes which give rise to the Secondary Hypertension I referred to earlier.

For instance underlying health issues could be:

  • Chronic Kidney Disease
  • Renovascular Disease
  • Hyperthyroidism
  • Hypothyroidism
  • Hyperparathyroidism
  • Hyperaldosteronism

Chronic Kidney Disease and Renovascular Disease both involve the kidneys, the former with regard to damage of the kidneys, whilst the latter concerns the integrity of the blood vessels supplying the kidneys.  In both cases the kidneys cannot function properly and this causes elevated blood pressure.

Hyper- and Hypothyroidism both involve the body producing too much (hyper) or too little (hypo) of the thyroid hormone which results in hypertension, especially Systolic Hypertension where the upper number is too high.

Hyperparathyroidism is a condition in which there is overactivity in one or more of the body’s 4 parathyroid glands which leads to an excess of the parathyroid hormone being secreted into the blood stream causing high blood pressure, and also kidney stones.

Hyperaldosteronism occurs when the adrenal glands, where the hormone aldosterone is produced, are not functioning normally.  This creates a condition where an imbalance in the level of aldosterone in the body leads to high blood pressure, and also due to imbalanced electrolyte levels possible low potassium levels.

When Secondary Hypertension is not the cause

But there are still those cases where resistant hypertension is not due to secondary hypertension … and these cases are the hardest nuts to crack and the ones which leave medical professionals scratching their heads.  In these situations it appears that lifestyle and genetic considerations have to be taken into account, and that the resistant hypertension may then be attributable to one or more factors such as:

  1. A Family History of high blood pressure
  2. African-American ethnic roots
  3. Hypertension due to a salt-hypersensitivity
  4. Excessive smoking or consumption of alcohol 
  5. Obesity 
  6. Being overweight and not getting enough exercise
  7. Age related

How to Treat Resistant Hypertension

Remember by the definition itself people with resistant hypertension will already be on three medications, including one diuretic.  So the first treatment option is to try changing medications and/or dosages to see if that will make a difference.  Since we are all individual in our makeups, then a change of medications may well be all that is required.

But if that isn’t successful then what?

The possibility that an underlying cause could be the culprit would then be the next logical step to be investigated which brings us back to Secondary Hypertension.   And in this area there are some options (depending on the underlying cause) which may be effective, and worth looking at especially if the prescription medication option is not doing the trick.

One new treatment which may be considered, where the underlying cause is related to renal or kidney disease, is a procedure called RENAL DENERVATION which focusses on nerves close to the kidneys which regulate blood pressure.  This newly developed procedure which is currently being trialled involves “calming down” some of these nerves by using a catheter to apply heat energy to the targeted nerves.

The other secondary hypertension causes relating to the abnormal functioning of the thyroid, parathyroid and the adrenal glands can all be treated successfully with medication, and in some cases surgery.

But Don’t forget the Lifestyle Changes…

These are still essential!  So along with the medical investigations and treatments, it is also very important not to forget about some key lifestyle changes which may very well play a role in the overall treatment plan for resistant hypertension.  These will include Diet changes, limited intake of salt - notably the refined table salt found in all sorts of processed and fast food products, limited consumption of alcohol, maintenance of a healthy weight, sufficient exercising and getting a handle on stress.

One diet which has been shown to be successful with not only helping high blood pressure but also in losing excess weight is the DASH Diet (Dietary Approaches to Stop Hypertension) and this is the diet I would recommend when it comes to making changes in what you are consuming.


Just one final thought: 

People with resistant hypertension should take the right medications in the right doses at the right time.

Always be mindful not to take medications, or even supplements, that can inadvertently raise blood pressure, e.g. diet pills and other stimulants, cyclosporine, ephedra, painkillers and NSAIDs - non-steroidal anti-inflammatory agents - such as Ibuprofen.  If in doubt about this then it is advisable to consult with your healthcare professional first…



  1. Efrain Lopez

    I will talk about resistant hypertension because this is exactly what I had in the past. Get a real RBC Magnesium blood test done. Not the regular serum test because this is the useless one every doctor ordered. This test measures the magnesium level in your heart. This is a major cause of High Blood Pressure. Once I got down to the root of my problem everything else I did seem to work well after that.

    Ever wonder why strong healthy people just drop dead? Lack of magnesium in the heart.

    Great post Nick.

    1. Nick (Post author)

      Your comment highlights some very interesting facts regarding the role of Magnesium, or deficiency thereof, as it applies to blood pressure, Efrain. This information you have provided regarding the proper blood test for Mg will give others out there, who are dealing with resistant hypertension, another avenue to investigate… and hopefully this might help them get to the root cause of their high blood pressure as well. I really appreciate you sharing your wisdom on this matter - many thanks!