Feeling Stuck With High Blood Pressure Even After Medication? 5 Things To Understand

Doctor reveals five alarming reasons your blood pressure stays high even after medication and what to do about it.

In a country where the burden of high blood pressure silently affects nearly 1 in 3 adults, emphasizing the critical need for regular blood pressure checks is no longer optional. It is lifesaving. Hypertension is often silent but never harmless. Early detection is critical — but so is what follows: interpretation, diagnosis and sustained treatment.

What happens when all the right steps are taken and blood pressure still stays high? In an interview with HT Lifestyle, Dr Viveka Kumar, Vice Chairman and Chief of Cath Labs (Pan Max) – Cardiac Sciences in Delhi, answered, “It’s called resistant hypertension. This advanced form of high blood pressure persists despite optimal doses of medication and consistent lifestyle changes.”

He shared, “Something as simple as checking your blood pressure can lead to life-saving interventions but for many patients, especially those already diagnosed and on treatment, the journey doesn’t end with measurement—it begins there. When we see persistently high readings despite medication and lifestyle changes, it’s a red flag for something more complex.”

Dr Viveka Kumar added, “Resistant hypertension is not a failure of effort—it’s often a sign that we need to dig deeper. It could indicate secondary causes like renal artery stenosis or hormonal imbalances, or even issues with how we measure and interpret blood pressure. Recognising this allows us to not just detect hypertension but to treat it with precision.”

1. Resistant hypertension is often missed or misunderstood

Dr Viveka Kumar said, “Most people assume that when blood pressure stays high despite medication, it’s just stress or wrong medication dose but resistant hypertension is a specific clinical condition. It means one’s blood pressure remains above target despite being on three or more medications, including a diuretic. Yet, many patients are never formally evaluated for it.”

The risk? Dr Viveka Kumar revealed, “Repeated dose changes, without ever uncovering the real cause. It affects an estimated 10% of people with hypertension and is often under-recognised or misattributed to poor adherence or inadequate treatment — when in fact, it may signal a more complex or secondary cause requiring specialised evaluation and care. An elevated BP reading isn’t the end of the story — it’s the start of deeper investigation. It is the start of taking control of your health.”

2. Skipping medications is more common than you think — and often looks like “resistance”

As per a study in the Mayo Clinic Proceedings Journal, anywhere between 50 to 80% of people with hypertension don’t take their medicines as prescribed. Whether it’s due to cost, confusion, or side effects, non-adherence is one of the leading causes of uncontrolled BP and can mimic resistant hypertension.

Before escalating treatment, Dr Viveka Kumar suggested it is crucial to check:

• Are medications being taken consistently?
• Are doses being adjusted appropriately?
• Are patients supported with the right information and follow-up?

It is time to take control.

3. It’s not just about the medication, other factors play a role too

While many assume that resistant hypertension simply means not taking medication as prescribed, the reality is often more complex. Dr Viveka Kumar explained, “Sometimes, it’s not just about the treatment, but about what’s happening inside the body. An overactive sympathetic nervous system can cause the body to stay in a constant state of “high alert,” narrowing blood vessels and increasing blood pressure, despite treatment.”

He added, “Other factors—like kidney disorders, hormonal imbalances (such as issues with aldosterone or thyroid function), or sleep apnea—can also contribute to high blood pressure that’s hard to control. Even certain medications, including pain relievers, steroids and antidepressants, can interfere with blood pressure. Lifestyle choices, like too much salt, alcohol, weight gain, or ongoing stress, can make the situation even worse.”

4. There are newer, interventional solutions beyond pills

When medications aren’t enough and secondary causes have been ruled out, interventional treatments are emerging as viable options. Dr Viveka Kumar elaborated, “One of the most promising is Renal Denervation (RDN), a minimally invasive procedure that targets the overactive nerves around the kidneys. By deactivating these nerves, RDN helps reduce blood pressure, offering hope for patients whose hypertension remains uncontrolled despite the medical therapy. The procedure is gaining attention in India’s advanced cardiac centers, particularly for patients who continue to struggle with high blood pressure despite exhaustive efforts with medications and lifestyle changes.”

5. India’s hypertension crisis makes resistant hypertension harder to catch and more dangerous to miss

India is facing a hypertension epidemic. With over 220 million adults living with high blood pressure, only 12% have it under control. These alarming figures, from the NFHS-5 and national health programs, underscore a troubling gap — not just in awareness but in the ongoing management of the condition. In this context, resistant hypertension often goes unnoticed.

Dr Viveka Kumar concluded, “Many patients are not screened thoroughly enough, secondary causes are overlooked, and interventional treatments remain limited to a few advanced centers in urban areas. It’s time to act don’t just measure, take control! Resistant hypertension is more common than we realise in India and if ignored, it can lead to serious long-term consequences.”

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.