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Some steps to control high blood pressure

Copyright 2002 President Fellows Harvard College behalf HMS MediServices Phoby LizGreen HMS MediServices Anthony Leader Komaroff MD Harvard Health Publications

Copyright 2002 President and Fellows of Harvard College on behalf of HMS Media Services, Photo by Liza Green, HMS Media Services, Anthony Leader Komaroff, MD, Harvard Health Publications

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Updated: January 14, 2013 6:32AM

Dear Doctor K: I’ve made lifestyle changes and take three blood pressure medications, but my blood pressure still isn’t where my doctor wants it to be. What else can I do?

Dear Reader: Sometimes high blood pressure doesn’t respond to lifestyle changes and medications. This is called resistant hypertension. It is blood pressure that lingers above target levels despite the use of three medications.

And controlling this matters. Heart disease, for example, is much more common in people with resistant hypertension than in people with controlled blood pressure.

One factor that may be contributing to your resistant hypertension is sleep apnea. If you do have sleep apnea, a type of drug called an aldosterone blocker may help.

Additional steps you can take:

Know your true blood pressure. Check your blood pressure at home a few times a day. Home blood pressure machines are very accurate these days; they’re also easy to use and relatively inexpensive. Home measurements are helpful because sometimes people have normal blood pressures except when they come to their doctor’s office. It’s called “white-coat hypertension.”

Optimize your medications. You’re probably already taking a thiazide diuretic; most people with high blood pressure should be. Many types of drugs can be added to the diuretic. Some people respond better to certain drug types than others. The time of day you take your medications may make a difference. So might taking one long-acting drug versus several short-acting medications.

Beware other pills and potions. Some drugs and supplements can boost blood pressure. Ask your doctor.

Get a checkup. In particular, get checked for conditions that contribute to resistant hypertension, such as several adrenal gland diseases, silent kidney disease and sleep apnea.

Shake the salt habit. People with resistant hypertension may be especially sensitive to the pressure-boosting effect of sodium. Keep your daily intake of sodium under 1,500 milligrams.

Stick with the standards:


*weight control

*eating more fruits and vegetables

*no smoking

*alcohol in moderation, if at all

*stress-relieving activities

A personal anecdote: I have mild high blood pressure that has been easily controlled with medicines for many years. Several months ago, my blood pressure started to go up. None of the conditions that can cause resistant hypertension turned up when I was tested. Increasing the doses of my medicines didn’t drop the pressures.

The only thing that was different was I had gained about four pounds on a vacation that was short on exercise and long on eating. When I lost 8 pounds over the next three weeks, my blood pressure dropped to normal.

Write to Dr. Komaroff at

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