6 Reasons Why Your Blood Pressure Meds Aren’t Working

How specialists tackle stubborn hypertension

blood pressure gauge illustration

What happens when medication doesn’t bring your high blood pressure under control?

A hypertension specialist looks at potential causes. Usually, it’s not just one single issue but various factors that contribute to the problem. Your doctor will work to figure out why – and from there, create a new plan of attack.

“Finding the right combination of medications for uncontrolled hypertension may require some trial and error,” says hypertension specialist George Thomas, MD.

In his work with patients, Dr. Thomas investigates possible explanations for difficulty in controlling blood pressures. These can include:

Reason 1: You could be experiencing ‘white coat’ hypertension

If you feel nervous about seeing a doctor, your blood pressure could spike at each appointment and give the false sense that your blood pressure is generally high.

Try arriving early at your appointment, then take deep breaths in the waiting room to relax.  Work to  manage your anxiety. The American Heart Association recommends that you sit quietly for at least five minutes before taking your blood pressure. Also, if you or your doctor suspect that it’s the actually the medical office itself spiking your blood pressure, you can talk about the options.

Reason 2: You might not be taking medications correctly or you could be taking other drugs that interfere

With complicated dosing schedules, people can forget to take medications or not take the correct doses at the correct time intervals.

Also, other drugs can interfere with blood pressure control, including pain relievers (NSAIDs), oral contraceptives and nasal decongestants. That’s why it’s good to bring all of your pill bottles, including over-the-counter medications or vitamins, to your appointments.

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Reason 3: You or your doctor’s office could be making mistakes in testing

Sometimes, people make mistakes in testing at home. Bring your home unit to your appointment and show it to your doctor to make sure it’s operating correctly. Make sure your arm cuff is the appropriate size for you. When you take readings at home, start by sitting quietly for five minutes. Then, be sure your back is supported, your feet are on the ground, and your arm is at heart level to get an accurate blood pressure reading.

Misreadings can also happen at your doctor’s office, says Dr. Thomas. The cuff might be the wrong size, or they might be taking a reading before you’re fully at rest.

To get a more accurate reading, Dr. Thomas takes six blood pressure readings in a row, each one minute apart, using an automated blood pressure machine. He or his staff observes the first reading but then you are alone in the room for the remaining five readings. They use the average of the last five readings to get the result.

Reason 4: You might be eating an improper diet

Dr. Thomas recommends the low sodium DASH diet for patients with hypertension — lots of fruits, veggies, whole grains and lean protein, with no more than 2.3 grams of sodium each day. You should check with your doctor if the DASH diet is appropriate for you.

You may not use the salt shaker, but perhaps you’re eating processed foods or using canned foods that contain high levels of sodium. Registered dietitians can show you how to spot sodium in nutrition labels to better manage your intake.

“Many people tell me they don’t add salt to their foods, and that’s great,” says Dr. Thomas. “But they often don’t realize how much sodium is already in the foods they eat.”

Reason 5: You’re overweight, inactive or you smoke

To help lower your blood pressure, work to lose weight, increase your physical activity and moderate your alcohol consumption as needed. If you smoke and can quit, it will lower your overall cardiovascular risk.

Reason 6: You could have other medical conditions that are affecting your blood pressure

Dr. Thomas often tests for vascular or hormonal issues that could be influencing a person’s uncontrolled hypertension, as well as thyroid problems or obstructive sleep apnea (OSA).

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What to do if you have resistant hypertension

Dr. Thomas says your blood pressure shouldn’t be higher than 140/90 mmHg (or higher than 150/90 mm Hg in older people). Resistant hypertension is blood pressure above the goal despite being on at least three different blood pressure medications at optimal doses.

“Each of those three medications should be from different classes, with one being a water pill,” Dr. Thomas says.

He says studies indicate that about 12 percent of patients meet those criteria.

If you have high blood pressure that isn’t responding to medication, your doctor may refer you to a hypertension specialist recognized by the American Society of Hypertension, Dr. Thomas says, as these cases often require in-depth testing and highly tailored treatment.

Once you have a specialist, he or she will investigate and create a personalized treatment plan for attacking stubborn hypertension.

“Everyone is different, and every treatment decision is an individual one,” he says.

Resistant Hypertension: Get Your Questions Answered

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  • JD

    I’m glad to know that the article was written for the average person, but would it have hurt to say “diuretic” instead of “water pill”? I believe that most people are familiar with the term, and that terminology made the article less effective.

    • km

      JD, are you kidding, that was not the brightest remark made, some
      persons do not know what a diuretic is, “water pill” was used for a
      reason. brussels sprouts are a natural “diuretic” Some people may think
      eating brussels sprouts is all they need to do.

      • radcont5164

        Tea and coffee are also diuretics.

  • Janice M Giaco

    There is a connection between gout and HTN, fructose metabolism in liver leads to Uric Acid buildup, the substance that causes gout. Uric A also interferes with the arterial nitrous oxide, leading to high BP…

  • LaPortaMA

    You didn’t learn to meditate, and the metaphor of antihypertensive medicine has failed.

  • RichW624

    “Dr. Thomas says your blood pressure shouldn’t be higher than 140/90 mmHg (or higher than 150/90 mm Hg in older people).” What age is older people?

    • Helpful Henry

      Article states 60+

    • Richard Gent

      What is the recommended B/P for 85 &up

  • Gregooch

    A healthy vegan or plant based diet will lower your weight, your cholesterol and your blood pressure all in one with no side effects. Check out Dr. Esselstyn’s book; forks over knives…

    • Jillxz

      I’m diabetic . Have type 2 diabetes. So far not on diabetic meds , but that might change. I cannot lose weight no matter what I try. When I first went on a diabetic diet , I lost 2 lbs a week for 5 weeks. A total of 10 lbs and then it all stopped. Haven’t been able to lose any more and I am still on the diet. I measure everything I eat. Cut out all things white . ,I don’t exercise as I also have COPD. I am at a lose as why I cannot lose weight.

  • Patty girl

    My BP almost never gets below 150/90 but I am in the older age group. My big problem is with Any type of stress it can spike to 180/99 . Any suggestions? Am on 3 BP meds.

    • The_Beating_Edge_Team

      Patty girl, my suggestion is that you should see a hypertension specialist – sometimes high blood pressure is related to nephrology (kidney) issues – and you may need to see a specialist to find out why your BP remains high on your medications – see https://my.clevelandclinic.org/florida/departments/nephrology_hypertension for more information on this specialty. betsyRN

  • bethmoore

    My BP is always 110/70 OR LESS yet I’m told I have high BP , why I don’t know except to get medicaid to pay for my new aortic valve.

    • Mario Ferreira

      Your BP is fine. Cleveland Clinic is the best in the US, first place for 15 years in Cardeology.
      Two years ago I flew up from Houston to Cleveland clinic to get a new aortic valve. I now have a bovine valve, minimal incision, great shape. I bike, swim and yoga. Feel great !!!!
      I don’t have eough words how CC is so professional, clean, and everything they mention, it happen. AWESOME PLACE

      • bethmoore

        I’m glad they didn’t spread your ribs & leave you with an ugly incision, its been 3 months for me-hoping to get that energy boost soon.

    • SunshineSunshineSunshine

      Perhaps it is 110/170?

    • karen2009

      You need a new physician if they are telling you that is high.

      • bethmoore

        I think they say that because without a bunch of meds it most likely would be high but with a new aortic valve it should be pretty good.

  • Katie Davison

    I was hoping this article would deal with both sides of the blood pressure issue as I am currently dealing with POTS (postural orthostatic tachycardia syndrome) which leaves me with hypotension – currently averaging BP 80/50 with meds that are not working. I was excited to see the title of this article until I realized it was only targeting those suffering from high BP…

  • Sherri Robertson

    It’s upsetting that I now have damage to my arteries from years of uncontrolled high bp, because none of the drs I’ve seen ever even suggested that I see a specialist. I’m thin, not diabetic, no thyroid problem, and none of the bp meds ever worked. I have just been given rx after rx. I’ve had two tachycardia attacks and get chest pain often. This should have been looked into already.but my Dr told me its probably due to a “predisposition ” which meant he doesn’t know why I have high bp.well, I stopped talking the other meds I was on (except the beta blocker and calcium channel blocker) and my bp is normal now. This I figured out myself……. But the damage is done. Don’t just ask why, insist on knowing the answer!!!!!!!!!!!!!!!!!

    • Dennis Horan

      Sherri would you be open to a conversation? I am on three pills and seen two drs one a spcialist and its 97 at times. Honestly dont know what to do. Dennis. skigolf88@yahoo.com

  • mony

    What do you do when blood pressure is 195/98 and the lowest it goes down is 165! !
    Female 45yrs its been almost two weeks and meds are not bringing down bloodpressure! !!

    • karen2009

      You cannot rely on medication alone. You have to combine it with diet and lifestyle changes. It’s the #1 reason why it is still high.

  • facebook

    Im looking for a doctor MD in Cleveland tx. I need my meds refilled bloodpressur pills, my thyroid pills filled, my zanax , pain pills, mucle relaxer, my inhalers, i have Copd. Had lung surgery, back surgery, shoulder surgery, and in the process of knee and removal of a tumor in my head. Any siggestions? I need to get my meds before i leave to move to Odessa Texas. On the 3rd r 4 th, i am disabled i have medicare and medicade.

  • SunshineSunshineSunshine

    My b/p 150s to 105 and meds no longer work. I can always feel my high b/p in my eyes and my forehead and my face gets red. I am considering saving money and not buying any meds. Diet does not help either, perhaps CHEMTRAILS are doing the damage regardless of all other healthy choices and lifestyles.

  • betty

    I have been on numerous bp tablets and every single one has made me really ill, I am beginning to wonder if there are any out there that suit me. Is there anyone else out there who cannot tolerate this type medication, and does anyone know the reason why some people are intolerant. Don.t know what the next step is now.

  • aetl

    I have tried 4 differents high bp meds (plus a water retention pill) and not only have they not worked I have had bad side effect reactions. From tiredness, coughing, simply no effect but the worst being ANXIETY. I HAVE NEVER EVER had such a bad experience in my life. (I’m 59). I was more comfortable when I was mugged. Horrifying isn’t a good enough description. Of course I have stopped taking it and I’m really afraid/reluctant to try yet another one. Yes maybe it is something they aren’t looking out for. We did discuss the white coat syndron but honestly the longer I’m waiting for the doctor the more nervous I become.

  • Barbara Evans-Blehm

    I take meds for high bp but sometimes it goes low and I can hardly walk across the room.

  • Barbara Evans-Blehm

    Because my bp goes up and down on 2 pills plus a water pill I asked my doctor if I should see a specialist and he had his nurse call and say no..,.my blood pressure is fine. I don’t think he realizes how weak I get when it goes low for no reason. I don’t understand and happy that it doesn’t go low that ofen.

  • radcont5164

    It has been proven that salt has no correlation to high blood pressure. Salt is used to create the Hydrochloric acid your stomach needs to help you absorb the nutrients in the food you eat. If you can’t absorb nutrients, your body gets it from other parts of your body, like your bones which creates other problems, like arthritis and mental decline. See…www.youtube.com/drwallach.