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Common Causes of Uncontrolled Hypertension

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Common Causes of Uncontrolled Hypertension

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This article describes common issues that may cause an increase in blood pressure in patients already taking medicines.

Medically reviewed by

Dr. Sneha Kannan

Published At April 24, 2019
Reviewed AtSeptember 16, 2023

What Is Uncontrolled Hypertension?

Uncontrolled high blood pressure is also called resistant hypertension. It refers to a condition when the blood pressure of an individual remains high or uncontrolled despite taking medications to control it. Hypertension or high blood pressure is one of the critical health issues. But what is more condemning is when the condition of the patient does not improve even with the proper treatment. Such patients are at a greater risk of having a stroke, renal disease, and cardiac arrest than those who respond well to the medications.

What Are the Signs and Symptoms of Uncontrolled Hypertension?

Uncontrolled or resistant hypertension manifests itself in the following ways:

  • When the blood pressure stays high, above 130/80 mmHg, even after taking three doses of anti-hypertensive medications, which includes one diuretic too.

  • When the patient takes four or more anti-hypertensive drugs to achieve normal blood pressure.

  • When there exists a secondary cause or an underlying medical condition, that prevents medications to control high blood pressure.

What Are the Causes of Uncontrolled Hypertension?

Most hypertensive people worry about their blood pressure not being controlled, and they visit the emergency room and clinic again and again. The reasons for uncontrolled hypertension are:

  • People do not regularly take antihypertensive medicines, they take them for a few days, and once the blood pressure normalizes, they quit. After a few days, their blood pressure shoots up again.

  • The other reason is patients do not follow dietary guidelines to control blood pressure. They eat without reins. They do not limit salt intake, fatty, and junk foods.

  • Many a time, they adhere to medicines and diet, but still, come to the emergency department for raised blood pressure. In such cases, the blood pressure is raised due to a panic attack, acute anxiety, and sudden awakening from sleep such as after a nightmare. In such cases, medicines do not need to be changed, but only relaxation and counseling by family members may be all that is required in order to normalize the pressure. After which, continue taking the same medicines at the prescribed doses.

  • Sometimes, blood pressure is controlled with one medication, but after some time such as a few years, the blood pressure rises again even with medicine. For this, the doctor increases the dosage of that medicine or adds another tablet.

  • Sometimes, taking some medicines for cold, pain, etc., may raise blood pressure. In such cases, blood pressure should be closely monitored, and the dose of the antihypertensive medicines may be increased for a few days and again reduced back to the previous dose, once the offending medication is discontinued.

Remember, only pills cannot control blood pressure when there is no family support, when one is not self-conscious, or when one does not have enough knowledge about this condition.

Other factors that can lead to uncontrolled hypertension are:

Lifestyle and Diet: The following aspects can contribute to the occurrence of both hypertension and uncontrolled hypertension:

  1. Obesity.

  2. Sedentary lifestyle.

  3. A high salt intake.

  4. Alcohol abuse.

  5. Drugs and Medications: Several drugs, whether prescribed or over-the-counter, can lead to deficient control of blood pressure. Such medications are:

  • Painkillers, particularly NSAIDs (non-steroidal anti-inflammatory drugs) such as Ibuprofen and Naproxen.

  • Nasal decongestants.

  • Birth control pills or oral contraceptives.

  • Herbal food items like ginseng, licorice, etc.

Secondary Causes: Sometimes uncontrolled hypertension develops due to secondary causes also which contribute greatly to raising blood pressure. Some of them are listed as:

  • Primary hyperaldosteronism which occurs because of increased production of specific hormones from the adrenal glands.

  • Renal artery stenosis results due to the narrowing of the arteries of the kidneys.

  • Chronic renal disease.

  • Sleep apnea.

  • Certain less common causes are pheochromocytoma which is an adrenal gland tumor; aortic narrowing; and Cushing syndrome, which occurs due to overproduction of certain steroid hormones.

How Is Uncontrolled Hypertension Treated?

To know the causative factor, the doctor advises investigations for kidney disease or increased hormone production from the adrenal gland. Imaging tests of the adrenal gland or kidneys may also be recommended to check their condition and the renal stenosis. A sleep test may also be required to know if sleep apnea is present or not. Additionally, a test for hypothyroidism may also be needed as hypothyroidism can also lead to high blood pressure.

Lifestyle changes can aid in improving the control of blood pressure. These measures include:

  • Restricting salt and alcohol consumption.

  • Limiting the intake of NSAIDs as a painkiller. Acetaminophen can replace them.

  • Engaging in aerobic activity for at least 30 minutes a day, 3 to 4 times a week.

  • Treating sleep apnea with devices that provide continuous positive airway pressure.

In more than one-third of uncontrolled hypertension cases, antihypertensive drugs do not work because of their improper intake. For the drugs to be effective, they must be taken in the recommended dose and also the prescribed number of times every day.

If the patient suffers from resistant hypertension in spite of taking all the medications as prescribed then let the doctor know about it, for he may include an additional drug to the list. The most commonly used anti-hypertensive drugs are diuretics, calcium channel blockers, and ACE inhibitors or angiotensin receptor blockers (ARBs).

Scientific studies claim that the intake of Chlorthalidone, a diuretic, acts as an adjunct to anti-hypertensive drugs in treating hypertension. Another diuretic, an aldosterone antagonist like Spironolactone may aid in controlling high blood pressure.

If, due to any reason, the patient finds it troublesome to take the medicine as prescribed, talk to the doctor about it. He would help in solving the issue that prevents the patient from taking all the advised doses. If adverse effects occur due to any drug then the doctor may replace it with a better option. The doctor may even switch to medicines that need to be taken just once daily. It is important to understand the medications should not be discontinued due to any reason or as advised by the doctor. One can consider getting online prescriptions to avoid any breaks between the course of medication.


Uncontrolled hypertension is a critical life-threatening issue that should not be ignored. The hypertensive patients should keep a regular check on their blood pressure readings and consult their treating doctor immediately if resistant hypertension develops. Resistant hypertension can be managed with the proper understanding of its cause, lifestyle alterations, and modifications in prescribed medications, if required.

Frequently Asked Questions


What Is the Most Common Cause of Uncontrolled Hypertension?

The most common cause of uncontrolled hypertension is the interrupted consumption of antihypertensive medications. Most people tend to continue medications only till symptoms are seen. Once the symptoms disappear, they discontinue the medications. This causes the blood pressure levels to rise again. Hence the course of the medications should be completed as the doctor prescribes to prevent uncontrolled hypertension.


What Causes Uncontrolled Blood Pressure?

- Irregular intake of anti-hypertensive medications.
- Excess consumption of junk food is high in triglycerides, fatty acids, and salt.
- Panic attacks and sudden stressful situations.
- Sedentary lifestyle.
- Lack of exercise.
- Medications like ibuprofen, NSAIDs (Non-steroidal anti-inflammatory drugs, painkillers, and birth control pills.


What Are Four Risk Factors for Hypertension?

The four most common modifiable risk factors of uncontrolled hypertension are:
- Hereditary.
- Age above 65 years.
- Underlying medical conditions like kidney disease or diabetes.
- Previous episodes of heart attacks. 
The four most common non - modifiable risk factors for uncontrolled hypertension are:
- Obesity.
- Sedentary lifestyle.
- A high salt intake.
- Alcohol abuse.


How Is Uncontrolled Hypertension Treated?

The following manages uncontrolled hypertension-
- Restricting salt and alcohol consumption.
- Quitting habits like smoking.
- Limiting the intake of NSAIDs (Non-Steroidal Anti-inflammatory Drugs) as a painkiller and replacing them with other alternative medications.
- Engaging in aerobic activity for at least 30 minutes a day, 3 to 4 times a week.
- Antihypertensive medications like diuretics (chlorthalidone), calcium channel blockers, and ACE inhibitors or angiotensin receptor blockers (ARBs).


Which Organ Is Affected by Uncontrolled Hypertension?

The adverse effect of hypertension (increased blood pressure) involves the following:
- Blood Vessels - The walls of blood vessels become weak.
- The Central Nervous System- Increased risk of stroke.
- Retina - High blood pressure can damage the blood vessels in the eye and cause retinal hemorrhage. 
- Heart - Decreases the blood and oxygen flow to the heart and causes heart failure.
- Kidneys - High blood pressure can cause renal failure.


What Are the Complications of Uncontrolled Hypertension?

The complications of uncontrolled hypertension include:
- Damaged blood vessels.
- Aneurysm.
- Heart attacks and other cardiovascular diseases.
- Brain damage.
- Dementia.
- Poor vision.
- Kidney damage.
- Sexual dysfunction.
- Pregnancy complications.


What Is Stroke Level Blood Pressure?

A blood pressure level that has the potential to cause a stroke is called stroke-level blood pressure. Blood pressure readings above 180/120 mmHg are believed to be dangerous and considered as stroke-level blood pressure. This is also called a hypertensive crisis. Extremely high blood pressure can damage blood vessels supplying various organs in the body and weaken arteries in the brain, increasing the risk of stroke.


Does Stress Cause High Blood Pressure?

Yes, stress is a potential risk factor to cause high blood pressure. Acute stress or temporary stress can increase your heart rate, cause palpitations and increase the response of the sympathetic nervous system, raising the blood pressure levels. Studies also suggest the release of stress hormones also raises blood pressure and causes chronic blood pressure or uncontrolled hypertension.


Can Anxiety Cause High Blood Pressure?

Yes, anxiety can cause blood pressure to rise. It can cause increased heart rate, contract the blood vessels, palpitations and hypoventilation (breathing too much carbon dioxide during anxiety), and low oxygen levels. Episodes of anxiety can cause drastic fluctuations and temporary spikes in blood pressure. However, long-term anxiety can cause chronic hypertension due to a constant and consistent increase in the level of stress hormones.


How Is Uncontrolled Hypertension Diagnosed?

Uncontrolled hypertension is diagnosed when-
- Blood pressure levels 160/90 mmHg (millimeters of mercury) even after the use of medications.
- When four or more anti-hypertensive drugs are required to achieve normal blood pressure.
- Presence of an underlying medical condition that prevents medications to control high blood pressure.


What Is Dangerously High Blood Pressure?

Dangerously high blood pressure is the blood pressure that has the potential to cause a stroke. It is also called stroke level blood pressure or dangerously high blood pressure as it may cause sudden heart attacks and even death. A blood pressure level of 160/90 mm Hg (millimeters of mercury) is considered as dangerously high blood pressure (high enough to cause a stroke).


Which Is the Proper Arm to Check Blood Pressure?

Some doctors prefer to measure the reading on the left arm; however, ideally, blood pressure should be measured in both arms as readings differ in the right and left arms. After measuring the blood pressure, the arm that recorded the higher blood pressure should be noted. Both arms should be measured because a significant difference in the right and left arm readings could signal vascular disease and a greater risk of dying from heart disease.


Are at-home Blood Pressure Machines Accurate?

At-home blood pressure monitoring devices help patients regularly monitor their blood pressure levels and keep them in check. Recent machines with newer advanced technologies have proven accurate enough to measure blood pressure levels. This helps doctors to understand whether the patient is taking the necessary precautions and controlling their diet.
Dr. Muhammad Zohaib Siddiq
Dr. Muhammad Zohaib Siddiq



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