Harvard Heart Letter

What to do when blood pressure resists control

Taming resistant hypertension requires extra attention from you and your doctor.

Among the 60 million Americans who know they have high blood pressure (also known as hypertension), fewer than half have it under control. Some of them haven't made the necessary lifestyle choices or aren't taking medicines to lower their blood pressure. Some of their doctors aren't prescribing the right medicines at the right doses. But some people with hypertension (about one in eight) are doing all the right things yet still can't manage to control their blood pressure. They have what's known as resistant hypertension — blood pressure that lingers above a preset target despite the use of three medications, or control achieved only with the use of four or more medications.

Good control makes a difference. Numbers from the National Health and Nutrition Examination Survey show that heart disease is much more common in people with resistant hypertension than it is among people with controlled blood pressure (see "Why blood pressure control matters").

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