If a patient has a poor response to blood pressure medication several factors could be contributing:
- Suboptimal Dosage: The doses of the medications might not be optimal for that particular patient. Different people might require higher or lower doses to achieve adequate blood pressure control.
- Poor Adherence: The patient may not be taking the medication as prescribed. Non-adherence is a common cause of treatment failure in hypertension. This could be due to forgetfulness, intentional omission due to side effects, or misunderstanding of the instructions.
- Secondary Hypertension: This refers to hypertension caused by an underlying, potentially treatable condition or disease such as:
- Primary aldosteronism (most common)
- Renal artery stenosis
- Chronic kidney disease
- Cushing’s syndrome
- Pheochromocytoma
- Hyperthyroidism
- Hyperparathyroidism
- White Coat Hypertension: Some patients have higher blood pressure readings in a clinical setting compared to their regular environment, possibly due to anxiety.
- Pseudoresistance: This includes issues like incorrect blood pressure measurement technique or equipment problems leading to falsely high readings.
- Drug Interactions: Common drugs that can increase blood pressure include NSAIDs, some antidepressants, steroids, and decongestants.
- Lifestyle Factors (SNAP):
- Smoking
- High salt intake,
- Excess alcohol consumption,
- Lack of physical activity
- Obesity
- Sleep Apnea: Obstructive sleep apnea is increasingly recognized as a cause of resistant hypertension.
- End-Organ Damage: Existing damage to organs like the heart or kidneys can reduce the effectiveness of antihypertensive therapies.