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When Blood Pressure is Hard to Control, Extra Help Is Needed

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Understanding Resistant Hypertension is Critically Important to Keeping Blood Pressure Down

What goes up must come down. That’s true when it comes to objects affected by the force of gravity, but it’s not always that easy when it comes to high blood pressure, which may need extra help to lower it.

Many people have high blood pressure (also called hypertension) that they’re able to control with lifestyle changes and, often, medications. But some have trouble keeping their blood pressure down, despite their best efforts.

When blood pressure stays elevated despite treatment with multiple medications, it’s called resistant hypertension. We know this problem affects a significant number of people who have high blood pressure: up to 20%, by some estimates.

As a cardiologist and medical director of the Temple Heart & Vascular Institute, I often see patients with resistant hypertension. To help them understand their condition — and what they can do to take control of their blood pressure — I start by explaining some causes of this condition.

Causes of resistant hypertension

There can be many reasons why a person’s high blood pressure is difficult to control. These may include:


Some people may have inherited genes that make them especially vulnerable to high blood pressure. High blood pressure may run in their family, as a result. The genes people inherit from their parents may affect the way their body handles salt or the way it controls the relaxation and contraction of muscles around blood vessels. These genetic traits can make it difficult to get blood pressure under control, even when a person takes medication and has healthy habits.

Medication issues

Many times, I will ask patients if it is even possible to manage the number of medicines they are taking or the number of times per day they should be taking them. As medical providers, we prescribe medications and therapies with the best of intentions. Patients try hard to take them as directed, but they may have obstacles that are difficult for them to control — like the cost of the prescriptions, remembering to take them at the prescribed times, or simply not wanting to take the medications but not wanting to disappoint the providers prescribing them. Successful blood pressure control is a team effort between the patient and their providers, and all these very real issues need to be discussed and managed. Openly discussing any concerns, obstacles and expectations you may have about your medications and how you take them is crucial to finding the right treatment for you.

Lifestyle factors

Problems with blood pressure can be magnified by (or caused by) a person’s lifestyle. For example, not exercising or having a diet high in sodium and salty, processed foods can make blood pressure worse.

Underlying causes

There are other causes of high blood pressure. These may include narrowing of the blood vessels that supply the kidneys or endocrine disorders, such as metabolic syndrome, prediabetes, and full-blown diabetes. Any of these secondary causes can cause blood pressure to rise. If the underlying condition is not managed, the high blood pressure that results can also be hard to manage.

Why it’s important to recognize blood pressure problems

High blood pressure typically does not cause symptoms. Many of my patients have high blood pressure and feel just fine. But even when it doesn’t lead to symptoms, hypertension causes a lot of problems when it is not treated and controlled. We can start to see some very significant changes in organ function, including the heart and the kidneys. This can lead to serious health problems, including kidney disease, heart failure, heart attacks, and stroke, which is a leading cause of adult disability. This is why it’s important to have regular blood pressure checks at your doctor’s office.

Temple’s team approach to taking blood pressure down

At Temple Health, we recently formed a Comprehensive Hypertension Program. In this program — a center of excellence — providers from different specialties work together to determine the best treatment options for patients with resistant hypertension.

Part of what we do is identify those secondary causes of high blood pressure. We know that some causes of high blood pressure are controllable, and patients might require less medication, if any, to achieve that control. Other patients benefit from changes to their medication regimen. At Temple, we work with each patient to find the right approach to control their blood pressure.

Get the help you need for high blood pressure

Temple has experts from many different specialties that can help with high blood pressure. The specialists in the Comprehensive Hypertension Program have diagnostic tools that can help identify contributing causes of high blood pressure and advanced treatment options.

To make an appointment with a Temple specialist, call 800-TEMPLE-MED or schedule an appointment online.

Helpful Resources

Looking for more information?

Daniel Edmundowicz, MS, MD, FACP, FACC

Dr. Edmundowicz is the Medical Director of the Temple Heart and Vascular Institute and has a special interest in cardiovascular disease prevention. He is national authority on the applications of atherosclerosis imaging to cardiovascular disease prevention and risk factor modification. He has lectured widely and published more than 80 peer-reviewed articles. He leads public health and epidemiologic studies and participates in multi-center clinical trials. Dr. Edmundowicz is a Fellow of the American College of Cardiology and past president of the ACC’s Pennsylvania Chapter. He is also a member of the American Heart Association and National Lipid Association.

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