Resistant Hypertension

Hypertension may be termed resistant to treatment, or refractory, when a therapeutic plan that has included

attention to lifestyle measures and the prescription of at least three drugs in adequate doses has failed to lower

systolic and diastolic blood pressure sufficiently, after 6 months of follow-up. In these situations, referral to a specialist should be considered, as resistant hypertension is known to be often associated with target organ damage.

Causes of resistant hypertension

1. Improper blood pressure Measurement.

2. Volume overload

   • Excess sodium intake

   • Volume retention from kidney disease

   • Inadequate diuretic therapy

3. Drug-induced

4. Other causes

  • Non-adherence

  • Inadequate doses

  • Inappropriate combinations

5. Associated conditions

   • Obesity

   • Excess alcohol intake

6. White coat hypertension

White Coat Hypertension

White-coat HTN (WCH) or “isolated office HTN” is a persistent elevation of BP in the physician’s office with normal BP at home or by ambulatory BP monitoring. Once suspected, BP must be