Editing Hypertension (section)

===Resistant hypertension===
Resistant hypertension is defined as high blood pressure that remains above a target level, despite being prescribed three or more antihypertensive drugs simultaneously with different [[mechanism of action|mechanisms of action]].<ref name="pmid38372970">{{cite journal | vauthors = Giacona JM, Kositanurit W, Vongpatanasin W | title = Management of Resistant Hypertension-An Update | journal = JAMA Intern Med | volume = 184 | issue = 4 | pages = 433–434 | date = April 2024 | pmid = 38372970 | doi = 10.1001/jamainternmed.2023.8555 }}</ref> [[Adherence (medicine)|Failing to take prescribed medications as directed]] is an important cause of resistant hypertension.<ref>{{cite journal | vauthors = Santschi V, Chiolero A, Burnier M | title = Electronic monitors of drug adherence: tools to make rational therapeutic decisions | journal = Journal of Hypertension | volume = 27 | issue = 11 | pages = 2294–2295; author reply 2295 | date = November 2009 | pmid = 20724871 | doi = 10.1097/hjh.0b013e328332a501 }}</ref>

Some common secondary causes of resistant hypertension include [[obstructive sleep apnea]], [[primary aldosteronism]] and [[renal artery stenosis]], and some rare secondary causes are [[pheochromocytoma]] and [[coarctation of the aorta]].<ref>{{cite journal | vauthors = Sarwar MS, Islam MS, Al Baker SM, Hasnat A | title = Resistant hypertension: underlying causes and treatment | journal = Drug Research | volume = 63 | issue = 5 | pages = 217–223 | date = May 2013 | pmid = 23526242 | doi = 10.1055/s-0033-1337930 | s2cid = 8247941 }}</ref> As many as one in five people with resistant hypertension have primary aldosteronism, which is a treatable and sometimes curable condition.<ref>{{cite journal | vauthors = Young WF | title = Diagnosis and treatment of primary aldosteronism: practical clinical perspectives | journal = Journal of Internal Medicine | volume = 285 | issue = 2 | pages = 126–148 | date = February 2019 | pmid = 30255616 | doi = 10.1111/joim.12831 | s2cid = 52824356 | doi-access = free }}</ref> Resistant hypertension may also result from chronically high activity of the [[autonomic nervous system]], an effect known as neurogenic hypertension.<ref>{{cite journal | vauthors = Zubcevic J, Waki H, Raizada MK, Paton JF | title = Autonomic-immune-vascular interaction: an emerging concept for neurogenic hypertension | journal = Hypertension | volume = 57 | issue = 6 | pages = 1026–1033 | date = June 2011 | pmid = 21536990 | pmc = 3105900 | doi = 10.1161/HYPERTENSIONAHA.111.169748 }}</ref> Electrical therapies that stimulate the [[baroreflex]] are being studied as an option for lowering blood pressure in people in this situation.<ref>{{cite journal | vauthors = Wallbach M, Koziolek MJ | title = Baroreceptors in the carotid and hypertension-systematic review and meta-analysis of the effects of baroreflex activation therapy on blood pressure | journal = Nephrology, Dialysis, Transplantation | volume = 33 | issue = 9 | pages = 1485–1493 | date = September 2018 | pmid = 29136223 | doi = 10.1093/ndt/gfx279 | doi-access = free }}</ref>

[[Refractory hypertension]] is described by one source as elevated [[blood pressure]] unmitigated by five or more concurrent antihypertensive agents of different classes.<ref name="acel">{{cite journal | vauthors = Acelajado MC, Hughes ZH, Oparil S, Calhoun DA | title = Treatment of resistant and refractory hypertension | journal = Circulation Research | volume = 124 | issue = 7 | pages = 1061–1070 | date = March 2019 | pmid = 30920924 | pmc = 6469348 | doi = 10.1161/CIRCRESAHA.118.312156 }}</ref> People with refractory hypertension typically have increased sympathetic nervous system activity, and are at high risk for more severe cardiovascular diseases and all-cause mortality.<ref name=acel/><ref>{{cite journal | vauthors = Dudenbostel T, Siddiqui M, Oparil S, Calhoun DA | title = Refractory hypertension: A novel phenotype of antihypertensive treatment failure | journal = Hypertension | volume = 67 | issue = 6 | pages = 1085–1092 | date = June 2016 | pmid = 27091893 | pmc = 5425297 | doi = 10.1161/HYPERTENSIONAHA.116.06587 }}</ref>