335Factors Associated with Pseudo-Resistant Hypertension
Clinicians should first attempt to exclude pseudo-resistant hypertension. For this to
happen, they have to actively consider, look for and eliminate the factors associated
with pseudo-resistant hypertension before a diagnosis of true resistant hypertension
is made. These factors can be patient or physician related.
Factors Associated with the Patient
- White coat effect.
- Severely calcified or arteriosclerotic arteries that are poorly compressible on pal-
pation, giving rise to cuff-related artefact (especially in elderly patients). Plain
X-ray of forearms and upper arms is usually sufficient to disclose heavily calci-
fied upper limb arteries. - Poor patient concordance with treatment/non-adherence to medications.
- Side effects of antihypertensive medication.
- Complicated dosing regimens.
- Inadequate patient education.
- Memory or psychiatric issues or poor cognition (especially in elderly patients).
- Difficult relationship between patient and doctor.
- Costs of drugs (in some healthcare systems).
Factors Associated with the Physician
- Poor office blood pressure measurement technique
- Clinical inertia
- Inadequate doses of antihypertensive drugs
- Inappropriate choice of antihypertensive combinations
- Poor communication and lack of time, or desire, to invest in patient education
It should be recognised that systolic BP elevation is much likelier, in older
patients, to prove to be resistant, because of the natural age-related widening of
aortic pulse pressure, due to progressive age-related arterial stiffening. Indeed, it is
important to stress that overzealous efforts to ‘crack’ systolic elevation of BP might
lead to inappropriate and potentially dangerous reductions in diastolic BP, upon
which coronary arterial blood flow is heavily dependent.
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