What are the causes of uncontrolled hypertension?

From the Guidelines

Uncontrolled hypertension is primarily caused by a combination of lifestyle factors, secondary causes of hypertension, and poor medication adherence, as identified in the 2018 American College of Cardiology/American Heart Association hypertension guideline 1. The causes of uncontrolled hypertension can be multifactorial, including older age, obesity, sleep apnea, diabetes, and chronic kidney disease, as noted in the 2008 American Heart Association scientific statement on resistant hypertension 1.

Key Factors Contributing to Uncontrolled Hypertension

• Lifestyle factors such as excessive sodium intake, physical inactivity, and weight management issues
• Secondary causes of hypertension, including sleep apnea, diabetes, and chronic kidney disease
• Poor medication adherence, which can be improved with once-daily dosing of antihypertensive medication and use of combination pills 1
• Use of substances that interfere with antihypertensive therapy, such as nonsteroidal anti-inflammatory drugs, stimulants, and oral contraceptives

Effective Management Strategies

• Identification and reversal of lifestyle factors contributing to treatment resistance
• Diagnosis and appropriate treatment of secondary causes of hypertension
• Use of effective multidrug regimens, including maximization of diuretic therapy and addition of mineralocorticoid receptor antagonists 1
• Referral to a hypertension specialist if blood pressure remains uncontrolled
• Team-based care approach, use of electronic health records, and patient registries to improve hypertension control and management 1

From the Research

Causes of Uncontrolled Hypertension

The causes of uncontrolled hypertension can be complex and multifaceted. Some of the key factors that contribute to uncontrolled hypertension include:

• Lack of awareness of hypertension status, with more than 50% of adults with uncontrolled hypertension being unaware of their condition 2
• Inadequate treatment, with 70.8% of treated individuals still having uncontrolled hypertension 2
• Poor adherence to medication regimens and lifestyle changes 3
• Presence of target organ damage, which can accelerate the progression of hypertension and make it more difficult to control 3
• Activation of the renin-angiotensin-aldosterone system, which can contribute to target organ damage and uncontrolled hypertension 3

Risk Factors for Uncontrolled Hypertension

Certain risk factors can increase the likelihood of developing uncontrolled hypertension, including:

• Age, with younger adults being at higher risk of uncontrolled hypertension 2
• Sex, with males being more likely to have uncontrolled hypertension than females 2
• Presence of other cardiovascular disease risk factors, such as diabetes and high cholesterol 4, 5
• Lack of health care visits and preventive care 2

Consequences of Uncontrolled Hypertension

Uncontrolled hypertension can have serious consequences, including:

• Increased risk of cardiovascular disease and mortality 4, 5
• Target organ damage, including damage to the heart, kidneys, and brain 3
• Increased risk of stroke, heart attack, and kidney disease 4, 5
• Decreased quality of life and increased healthcare costs 6