Secure online access to Cleveland Clinic's specialists for over 1,200 medical diagnoses, nutritional consultation and pre-adoption advice

Cleveland Clinic News  The latest from our experts

High Blood Pressure? 8 To-Do’s When Your Medication Isn’t Enough

Blood Pressure ReadingIf your blood pressure has crept up over the years, you likely take one or more drugs to help bring it down. But what happens when medication isn’t enough to control your hypertension, or high blood pressure?

Although hypertension is often treated successfully with medication and lifestyle changes, resistant hypertension is not so easy to address.

What is resistant hypertension?
“Resistant hypertension is the failure to reach goal blood pressure in patients who are adhering to maximally tolerated doses of an appropriate three-drug regimen that includes a diuretic,” explains hypertension specialist George Thomas, MD.

In other words, if you’re taking the maximum dose of three blood pressure medications, and one of those is a diuretic (water pill), and your blood pressure still isn’t at safe levels, you may have resistant hypertension. And you’ll need to do more to control it.

High blood pressure is sometimes known as “the silent killer” — so named because it increases the risk of heart disease and stroke, but often goes unnoticed due its lack of obvious symptoms.

Confirming this diagnosis
Diagnosing resistant hypertension isn’t always simple, though. “Proper measurement of blood pressure and confirmation is key,” Dr. Thomas says.

That means you’ll first need to make sure you’re getting accurate readings.

There are several reasons why you might get an inaccurate reading. This can happen if:

  • The blood pressure cuff is too small.

  • You haven’t rested long enough before checking blood pressure.

  • You experience “white coat hypertension,” or elevated blood pressure due to anxiety in the doctor’s office.

  • You smoke or have caffeine right before having your blood pressure taken. (This can artificially inflate the numbers.)

  • If you rule out all of those factors, and your blood pressure is still elevated, your may have resistant hypertension.

What’s causing it?