Causes of Refractory Hypertension
- • Pseudoresistance
- • White-coat hypertension (see measurement)
- • Pseudohypertension in older patients (rare)
- • Use of small cuff in patients who are obese
- • Nonadherence to prescribed therapy; present to some degree in 50%
- • Volume overload
- • Drug-related causes
- • Doses too low
- • Wrong type of diuretic
- • Inappropriate combinations
- • Drug actions and interactions
- • Sympathomimetics
- • Nasal decongestants
- • Stimulants, particularly medications for attention deficit hyperactivity disorder (methylphenidate), narcolepsy (modafinil), and appetite suppressants
- • Cocaine
- • Oral contraceptives (rare)
- • Adrenal steroids
- • Licorice (as may be found in chewing tobacco)
- • Cyclosporine, tacrolimus
- • Erythropoietin
- • Antidepressants, particularly monoamine oxidase inhibitors and the selective serotonin reuptake inhibitors-SSNI venlafaxine
- • Nonsteroidal antiinflammatory drugs
- • Concomitant conditions
- • Obesity
- • Sleep apnea (present in up to 90% of patients with RH)
- • Ethanol intake of more than 1 oz (30 mL) per day
- • Severe emotional trauma resulting in labile blood pressure surges (pseudopheochromocytoma)
- • Anxiety, hyperventilation
- • Secondary causes of hypertension (e.g., primary aldosteronism, renovascular hypertension, adrenal causes, and kidney disease, etc.)
