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What to do if your blood pressure does not decrease

Identifying and addressing underlying issues, as well as making lifestyle adjustments, will aid in recovery.


Many people develop hypertension as they age, and it can be difficult to regulate. This is referred to as resistant hypertension – blood pressure that remains above a predetermined target, such as 140/90 millimeters of mercury (mm Hg), despite the use of three distinct classes of blood pressure medications (including a diuretic) at the maximum tolerated doses. The disorder is a significant risk factor for stroke, heart disease, and dementia, among other complications. How can you bring it under control?



All drugs should be reviewed.


Bring a list of all the prescriptions you are currently taking to your doctor or a bag with all the medication bottles. Include OTC medications, vitamins, and supplements. The list, or bag, of medications, might assist your doctor in determining which medications or supplements may be increasing your blood pressure.

For instance, nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen (Motrin, Advil) might cause an increase in blood pressure. Decongestants (such as phenylephrine, which is present in a variety of cold medications), some antidepressants, and corticosteroids can also help. For instance, "alternative drugs or physical therapy can help minimize or eliminate the need for NSAIDs in some patients," according to Harvard cardiologist Dr. Deepak L. Bhatt, editor in chief of the Harvard Heart Letter.

Alternatively, the doctor may determine that your medications can be simplified: fewer pills overall or fewer pills that must be taken more than once a day.

Treat the underlying causes


Additionally, underlying disorders can contribute to persistently high blood pressure (see "What causes resistant hypertension?"). It is critical to bring them under control. However, determining whether or not you have one may necessitate some detective work as well as a comprehensive medical examination.

For instance, you may be unaware that you have a condition that increases blood pressure, such as sleep apnea – breathing pauses during sleep. Sleep apnea symptoms include chronic loud snoring, a momentary cessation of breathing (and possibly gasping for air), and excessive sleepiness during the day. A sleep study conducted in a laboratory or at home (with a portable device) can give information.


What factors contribute to resistant hypertension?


Resistant hypertension (high blood pressure that does not decrease despite various drug treatments) can have a variety of causes. The most common reasons include consuming too much salt, which can reduce the effectiveness of blood pressure drugs; and missing doses or modifying them on your own. Additional reasons include the following:

gaining weight
obstructive sleep apnea
excessive alcoholic consumption
chronic pain
atherosclerosis is a condition in which arterial walls become inflamed.
interactions between medications
Panic attacks
elevated aldosterone levels (which causes the body to hold on to sodium and water)
kidney issues
consuming licorice noir (which contains a compound that can increase blood pressure).

Make improvements to your lifestyle


To reap the benefits of healthy habits, you may need to intensify them. Begin with a low-sodium plant-based diet; aim for less than 2,400 milligrams (mg) of salt per day. Additionally, you should get at least seven hours of sleep per night, consume moderate amounts of alcohol, abstain from smoking, and keep a healthy weight. "Sometimes, decreasing just 5 or 10 pounds can make a significant effect in patients who are overweight's blood pressure," Dr. Bhatt explains.

And if you're not exercising regularly, now is the time to begin. Exercise enhances cardiovascular health in various ways. Additionally, a small randomized trial published online on Aug. 4, 2021, in JAMA Cardiology reveals that aerobic exercise (the type that gets your heart and lungs pounding) may be another effective treatment for resistant hypertension.

The study found that participants who walked, cycled, or did both for 40 minutes three times a week for 12 weeks reduced their blood pressure by seven points in the top (systolic) reading and five points in the bottom (diastolic) reading, compared to those who did not exercise.

What further can be done?


If these techniques do not work to lower your blood pressure, your doctor may feel the need to prescribe additional medications. However, do not despair. "No matter what you're taking currently, your doctor should be able to make affordable changes in your blood pressure meds to get your numbers down," Dr. Bhatt adds.

Blood pressure

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