What Is Resistant Hypertension? 

Resistant hypertension describes a type of high blood pressure that is resistant or unresponsive to treatment.¹ It is typically defined as uncontrolled blood pressure in hypertensive individuals despite the use of three or more of different classes. The different classes usually include a calcium channel blocker (CCB), a diuretic, and either an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). To diagnose resistant hypertension, and medication nonadherence must be ruled out.

Is Resistant Hypertension Associated With More Health Risks?

It is important to recognize and diagnose resistant hypertension because it comes with increased health risks.¹ Clinical trials and observational studies have found that people with resistant hypertension are at an increased risk of cardiovascular diseases (CVDs) when compared to people with controlled hypertension, presenting with increased risk of heart attack, heart failure, or stroke. Additionally, these individuals also have higher prevalence of other comorbidities such as chronic kidney disease, diabetes, other heart disease, and cerebrovascular disease, which further increases the risk of adverse cardiovascular events. High blood pressure is a known risk factor for various kinds of CVDs, and people with resistant hypertension are more likely to have a longer history of having severely elevated blood pressure, predisposing them to a greater CVD risk than those whose blood pressures have been adequately controlled by treatment.

How Is Resistant Hypertension Treated?

Resistant hypertension is usually treated with a combination of both lifestyle changes and pharmacological interventions.^1,2 A typical treatment regimen for resistant hypertension includes a type of ACEIs or ARBs, a CCB, and a thiazide-like diuretic.² If these three different classes of medications at the optimal or maximal dosage still cannot control blood pressure, an additional medication called a mineralocorticoid receptor antagonist is considered. Studies have shown that resistant hypertension is commonly caused by an excess of a hormone called aldosterone. Therefore, the addition of a class of medication that blocks the action of aldosterone on mineralocorticoid receptors can help reduce blood pressure. The most frequently used type of mineralocorticoid receptor antagonist is spironolactone. 

In addition to these medications, making appropriate lifestyle changes is crucial.^1,3 Reducing the intake of sodium is one of the key ways to reduce blood pressure. It is recommended that sodium intake to be reduced to less than 2,300 mg per day. Engaging in regular exercise and eating a heart-healthy diet are also important, as well as reducing the intake of alcohol. Additionally, many people with resistant hypertension have obstructive sleep apnea, a sleep disorder, which can exacerbate hypertension. Receiving appropriate treatment for obstructive sleep apnea, such as using the continuous positive airway pressure, can also help improve blood pressure.