How to Tame Stubbornly High Blood Pressure, From the September 2014 Harvard Heart Letter

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Nearly 10 percent of people with high blood pressure have resistant hypertension, meaning their blood pressure is still high despite taking at least three medications. Taking combination pills, exercising, and eating less sodium can help.

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High blood pressure is a leading cause of stroke and heart disease. Dozens of medications and other therapies are available to treat high blood pressure, also known as hypertension. Yet many people can't get their blood pressure under control even by taking multiple medications, reports the September 2014 Harvard Heart Letter.

"When people have high blood pressure despite being on three different medications, including a thiazide diuretic, they have what's known as resistant hypertension," says Dr. Joshua Beckman, a cardiologist at Harvard-affiliated Brigham and Women's Hospital.

Some people with resistant hypertension may have "white-coat hypertension." This means their blood pressure is high in a doctor's office or other medical setting but normal at home. White-coat hypertension is thought to result from stress or anxiety, which raises blood pressure. To rule this out, a doctor may recommend using a home blood pressure monitor or a device that automatically takes blood pressure every 15 to 30 minutes over a 24-hour period.

Other people with resistant hypertension may not be taking their medicines correctly. To help his patients stick to their medication schedules, Dr. Beckman lowers the number of pills they need to take each day. That's often easy because many common, generic blood pressure medications are available in combination pills. "Initially, doctors often prescribe single-ingredient medications because it's easier to adjust the dosage. But once you get to a certain dose on several drugs, it's better to switch to a combination drug," he says.

A number of other things can help lower blood pressure independent of medications. At the top of the list: daily exercise and weight loss for people who are overweight. Other tips include:

  •     Eat more potassium-rich fruits and vegetables. Potassium helps lower blood pressure. Good choices include tomatoes, spinach, sweet potatoes, avocados, dried apricots, bananas, oranges, and cantaloupes.
  •     Try not to eat processed and restaurant-prepared foods. These foods can be loaded with sodium, which raises blood pressure. Common sources of extra sodium include cold cuts and cured meats, pizza, soups, sandwiches, and cheese.
  •     Go easy on alcohol. Too much alcohol can raise blood pressure. Men should have no more than two drinks per day; women should have no more than one drink per day.
  •     Check over-the-counter medications. Many drugs can boost blood pressure. Common ones include painkillers such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Anaprox) as well as cold and flu remedies that contain decongestants such as pseudoephedrine, phenylephrine, and oxymetazoline, or eye drops such as naphazoline.

Read the full-length article: "How to tame stubbornly high blood pressure"

Also in the September 2014 issue of the Harvard Heart Letter:

  •     Who needs a blood transfusion for heart surgery?
  •     Digoxin's new life for treating heart failure
  •     Understanding bundle branch block

The Harvard Heart Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $20 per year. Subscribe at or by calling 877-649-9457 (toll-free).


Media: Contact Kristen Rapoza at hhpmedia(at)hms(dot)harvard(dot)edu for a complimentary copy of the newsletter, or to receive our press releases directly.

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Kristen Rapoza
Harvard Health Publications
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