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Resistant Hypertension, who should be tested?

By: Dr Punit Ramrakha

Published Date: 08/01/21

Despite investigation, 90% of patients have no underlying cause identified for their high blood pressure. However 1 in 10 patients have an underlying anatomical or hormonal problem that is the ‘cause’ of the high blood pressure. Addressing this makes managing the blood pressure easier. Many doctors mistakenly see "treatment-resistant hypertension" as a problem of noncompliance with medication. It is much more often the result of a missed diagnosis and inadequate intervention.

Overproduction of the hormone, aldosterone, is an under-diagnosed cause of hypertension, and may account for 15-20% of cases of “resistant hypertension” in some studies ( However, a recent study has highlighted that far too few people (less than 2%) are getting tested for this (

Overproduction of aldosterone is associated with a higher rate of cardiovascular morbidity and mortality when compared with age- and sex-matched patients with primary hypertension and the same degree of blood pressure elevation. In patients diagnosed with aldosterone overproduction, treatment of this results in reversal or improvement of the raised BP and resolution of the increased cardiovascular risk. A simple blood test can help screen for the problem, and the treatment may be as simple as a drug (spironolactone or eplerenone).

Who should be tested?

Any patients with high blood pressure and :- ●Consistently low potassium on blood tests ●Drug-resistant' hypertension ●Abnormalities on scan of adrenal glands ●Sleep apnea ●A family history of early-onset hypertension or cerebrovascular accident at a young age (<40 years) ●Atrial fibrillation

Dr Punit Ramrakha, Consultant Cardiologist, on ‘Resistant Hypertension, who should be tested?' - 8 January 2021


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