Why Can’t I Get My Hypertension Under Control?

It is important to distinguish this from "resistant hypertension," a specific type of uncontrolled blood pressure. It stays high even when a person is taking three or more different types of blood pressure medications.

Addressing the heart of the problem is key because uncontrolled hypertension can lead to a variety of serious health risks, including heart attack, stroke, heart failure, irregular heart rhythm, kidney disease, dementia, and peripheral arterial disease. But it can be treated.

“Overall, uncontrolled hypertension is the leading preventable cause of cardiovascular disease worldwide and shortens life expectancy when left untreated,” Hwang says. “Managing blood pressure can lower these risks.”

Why It Impacts the Body

When your blood pressure is high for too long, it can damage the walls of the blood vessels. In an effort to repair the damage, your body sends in special cells (think: reinforcements) that stick to the tear, but the weakened wall is now vulnerable to the buildup of cholesterol and fats. This is called plaque and it blocks the passageway for the healthy blood flow that your body depends on to receive important nutrients, like oxygen.

As time goes on, persistently high blood pressure leads to hardening and narrowing of the arteries (called atherosclerosis) that reduces blood flow to crucial organs and tissues. This signals several nervous system and hormonal responses to trigger an increase in sodium retention and water intake, making it difficult to control blood pressure. This harms your heart, brain, kidneys, and eyes. It can also damage arteries in your legs as well as the aorta, the main artery carrying blood throughout the body. Hwang notes that the physical effects can also contribute to mental health issues, too, including dementia and cognitive decline.

Common Causes

If you are taking your medicine but your numbers are still high, it can be frustrating. Several factors often work together to keep blood pressure elevated.

Lifestyle factors

Certain lifestyle factors may influence hypertension and your general health even if you’re on medication to regulate your hypertension.

Eating processed foods – which have excess salt (sodium) – causes your body to hold on to fluids, resulting in increased pressure in your arteries.

Lack of consistent aerobic exercise may also contribute to the heart’s inability to pump blood, which can keep pressure high.

Drinking too much alcohol (more than one alcoholic drink per day for women and more than two drinks per day for men) can significantly raise blood pressure and interfere with medications.

And finally, use of tobacco products can cause your blood pressure to increase and lead to damaged arteries.

Unrelated medical conditions

There may also be less obvious causes for uncontrolled hypertension in the form of a seemingly unrelated medical condition called “secondary hypertension.” Common culprits include sleep apnea, kidney disease, thyroid problems, pregnancy, use of birth control pills, and alcohol addiction.

Medication and supplement interactions

Improving Uncontrolled Hypertension

According to Hwang, managing uncontrolled hypertension typically begins by adopting healthy lifestyle habits, including an overall practice of healthy eating foods, staying physically active, getting good sleep, and managing your body weight. “A healthy eating plan for blood pressure includes fruits, veggies, whole grains, low-fat dairy, fish, skinless poultry, beans, and nuts,” he says. “Use plant-based oils such as olive or avocado oil.”  General rules of thumb when trying to manage hypertension through diet are:

• Limit sodium (less than 1,500 milligrams per day).
• Cut down on saturated fat (typically found in fatty meats, full-fat dairy, and tropical oils such as palm and coconut oil).
• Limit sugary foods and drinks.
• Reduce or quit drinking alcohol. 
• Eat foods rich in potassium.

High blood pressure can be monitored by your primary care doctor. When needed, they may refer you to a cardiologist (heart doctor) or nephrologist (kidney doctor). When a hormonal disorder is thought to be the cause of high blood pressure, it may be helpful to add an endocrinologist to your team.

“If your risk is high enough to warrant blood pressure medications, there are many options that your health care provider can discuss with you,” Hwang says. “Most of these are available in generic forms to be taken once daily. Measure your blood pressure at home with an accurate cuff to monitor progress. Follow up regularly with your health care provider to see if changes need to be made.”

Despite its name, uncontrolled hypertension can be managed, but it may take more than one approach. Making lifestyle changes and being aware of drug or supplement interactions are key.

“The good news is that healthy lifestyle habits and blood pressure medications, when appropriate, can go a long way toward controlling blood pressure,” Hwang says, “even in people who have a family history of uncontrolled hypertension.”