Hypertension is considered refractory if the blood pressure (BP) cannot be reduced below 140/90 mmHg in patients who are compliant with an appropriate triple-drug regimen that includes a diuretic, with all the component prescribed in near maximal or tolerated doses.
The most common causes are poor compliance, alcohol access and obesity. In addition, blood pressure becomes increasingly difficult to control in the presence of deteriorating renal function.
Additional etiologies include renal artery, stenosis, sleep apnea and the other secondary causes of hypertension. Other causes: nonadherence to therapy, white coat hypertension, pseudo-hypertension, antihypertensive drug dose too low, and sedentary lifestyle.
Approximately 10% of patients with refractory hypertension will have a secondary cause, medication use and compliance, nonpharmacologic management strategies and excessive alcohols use are frequently overlooked causes.
Causes of refractory hypertension
