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Resistant Hypertension And Other Reasons Your BP Meds Are Not Working

Resistant Hypertension And Other Reasons Your BP Meds Are Not Working

You’ve been taking your antihypertensive medications correctly. But despite doing so, your blood pressure is still high. Do you need to change your medicine? Is it your diet? Or perhaps you’re experiencing what doctors call “resistant hypertension.” Let’s talk about the possible reasons why your antihypertensive medicine is not working.

Possible Reasons Why Your Antihypertensive Drugs Are Not Working

Usually, when antihypertensive medicines don’t seem to work, it’s due to a combination of reasons. These factors may even make you feel like you have resistant hypertension — one that doesn’t respond to aggressive treatment.


A diet high in salt may increase your blood pressure. If you’re hypertensive, your diet should have lots of fruits and vegetables, whole grains instead of refined carbohydrates, lean protein, and healthy fats.

Instead of adding salt to your meals, consider other herbs and spices. Also, don’t forget to read food labels: You may not be using salt, but many processed meat and packed foods contain too much sodium.

Lifestyle Factors

If you feel like you have resistant hypertension, check the following lifestyle factors1:

  • Smoking. It narrows the blood vessels and makes the heart beat faster, leading to high blood pressure.
  • Alcohol consumption, especially when excessive, increases some people’s BP.
  • Stress also increases blood pressure.
  • Losing weight lowers the BP of individuals who are overweight. Regular exercise also seems to improve blood pressure, especially since it can help manage weight.

Factors Involving Your Medicines

Experts say finding the right medication sometimes requires a “trial and error” approach. Hence, your doctor may need to change your medicine.

Another possibility is that you’re taking your medicine incorrectly (skipping a dose, etc.) or you have another medicine or supplement that causes drug interaction.

For instance, oral contraceptives, pain killers, decongestants, and some herbs may interfere with your antihypertensive drug’s effectiveness.

White Coat Hypertension

Finally, white coat hypertension can also result in seemingly resistant hypertension, especially when you don’t monitor your blood pressure regularly.

White coat hypertension is when BP spikes occur during your doctor’s appointment.

Since it is usually due to anxiety, experts recommend arriving at the facility early to relax and perform breathing exercises.

What About Resistant Hypertension?

Resistant hypertension occurs when your blood pressure is still high despite aggressive medical treatment. To be more specific, resistant hypertension has the following criteria:

  • You are taking three blood pressure drugs and one of those drugs is a diuretic, which works by removing salt and fluid from the body.
  • Your blood pressure remains higher than your goal, which is usually at or below 130/80. However, each person has a different BP goal, so this should be discussed with your doctor.
  • You need to take at least four medicines to keep your BP controlled.

Addressing resistant hypertension should be a priority because it increases your risk of serious diseases, like heart attack, stroke, and heart failure.

Treatment for Resistant Hypertension

If you have resistant hypertension, the doctor will conduct tests to see if another health condition contributes to your uncontrolled blood pressure.

Below are some of the conditions that may contribute to resistant hypertension:

  • Obstructive sleep apnea
  • Thyroid problems
  • Kidney artery stenosis, where the blood vessels that carry blood to the kidneys are narrowed.

Once the doctor identifies the problem, they can start treating it and see if the blood pressure will be controlled. However, please note that the majority of resistant hypertension cases have no known cause. In those instances, management focuses on antihypertensive drugs and lifestyle modifications.

Key Takeaways

Why are your antihypertensive medicines not working? According to experts, it might be due to a combination of factors, like your diet, increased weight, and unhealthy habits, such as smoking and excessive alcohol consumption.

If you’re taking care of these factors and still don’t reach your target BP measurement, you might have resistant hypertension, which means your blood pressure is still high despite aggressive medical treatment.

Learn more about Hypertension here.


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Hello Health Group does not provide medical advice, diagnosis or treatment.


1) High Blood Pressure, https://www.aafp.org/afp/2004/1015/p1542.html, Accessed September 22, 2021

2) 6 Reasons Why Your Blood Pressure Meds Aren’t Working, https://health.clevelandclinic.org/6-reasons-why-your-blood-pressure-meds-arent-working/, Accessed September 22, 2021

3) Resistant Hypertension: Diagnosis, Evaluation, and Treatment, https://www.ahajournals.org/doi/10.1161/circulationaha.108.189141, Accessed September 22, 2021

4) Resistant Hypertension, https://www.hopkinsmedicine.org/health/conditions-and-diseases/high-blood-pressure-hypertension/resistant-hypertension, Accessed September 22, 2021

5) Overcoming resistant hypertension, https://www.health.harvard.edu/diseases-and-conditions/overcoming-resistant-hypertension, Accessed September 22, 2021

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Written by Lorraine Bunag, R.N. Updated Sep 23, 2021
Fact Checked by Vincent Sales