Resistant hypertension means blood pressure above target despite three drugs of different classes, including a diuretic, at adequate doses. Many patients labelled resistant are not: they miss doses, have white-coat readings, or take drugs that raise blood pressure.
A careful history and home readings settle most of these before further drugs or investigations.
- Confirm the patient is taking a diuretic, a calcium-channel blocker and a RAS blocker at adequate doses.
- Check home or ambulatory readings to exclude a white-coat effect.
- Review NSAIDs, decongestants and excess salt or alcohol.
- Consider secondary causes, such as primary aldosteronism and sleep apnoea, once pseudo-resistance is excluded.
Why it matters
Pseudo-resistance is common, and escalating treatment on clinic readings alone risks hypotension at home.
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