Confirm the blood pressure pattern before labeling resistance

Repeated, correctly measured blood pressure and treatment history determine whether hypertension is truly persistent.

Primary aldosteronismExcess aldosterone can sustain hypertension even without low serum potassium.
Kidney or renovascular diseaseKidney function or renal-artery problems may contribute to resistant readings.
Obstructive sleep apneaSleep-related breathing obstruction can sustain elevated blood pressure.
Medicine or stimulant effectsDecongestants, NSAIDs, stimulants and other exposures may raise BP.
White-coat or measurement artifactCuff size, rest period and technique can make readings misleading.

Sudden spells have a different differential

Brief severe episodes with palpitations and sweating require medical evaluation, although such symptoms have many possible causes.

Kidney or renovascular diseaseKidney function or renal-artery problems may contribute to resistant readings.
Obstructive sleep apneaSleep-related breathing obstruction can sustain elevated blood pressure.
Medicine or stimulant effectsDecongestants, NSAIDs, stimulants and other exposures may raise BP.
White-coat or measurement artifactCuff size, rest period and technique can make readings misleading.
Primary aldosteronismExcess aldosterone can sustain hypertension even without low serum potassium.

White-coat and masked hypertension are better assessed using suitable home or ambulatory monitoring.

Obstructive sleep apneaSleep-related breathing obstruction can sustain elevated blood pressure.
Medicine or stimulant effectsDecongestants, NSAIDs, stimulants and other exposures may raise BP.
White-coat or measurement artifactCuff size, rest period and technique can make readings misleading.
Primary aldosteronismExcess aldosterone can sustain hypertension even without low serum potassium.
Kidney or renovascular diseaseKidney function or renal-artery problems may contribute to resistant readings.

Secondary causes such as primary aldosteronism, kidney disease or sleep apnea merit clinician-directed consideration.

Medicine or stimulant effectsDecongestants, NSAIDs, stimulants and other exposures may raise BP.
White-coat or measurement artifactCuff size, rest period and technique can make readings misleading.
Primary aldosteronismExcess aldosterone can sustain hypertension even without low serum potassium.
Kidney or renovascular diseaseKidney function or renal-artery problems may contribute to resistant readings.
Obstructive sleep apneaSleep-related breathing obstruction can sustain elevated blood pressure.