Information

Why does high blood pressure not damage the body during exercise?


Exercise is commonly understood to lower blood pressure by making the heart stronger. Mayo Clinic says,

Regular physical activity makes your heart stronger. A stronger heart can pump more blood with less effort. If your heart can work less to pump, the force on your arteries decreases, lowering your blood pressure.

While exercising, though, systolic blood pressure will often go up significantly.

Why does this dramatic increase in blood pressure not damage the cardiovascular system? Stress, for example, can damage the blood vessels,

Increases in blood pressure related to stress can be dramatic. But when your stress goes away, your blood pressure returns to normal. However, even frequent, temporary spikes in blood pressure can damage your blood vessels, heart and kidneys in a way similar to long-term high blood pressure. (Mayo Clinic)

Does daily exercise, for example, not cause "frequent, temporary spikes in blood pressure"?

Why does a blood pressure increase from exercise not damage the cardiovascular system as a similar blood pressure increase from stress (or other sources)?


Actually it can. See https://clinicalhypertension.biomedcentral.com/articles/10.1186/s40885-016-0052-y for instance:

Deleterious effects of HRE [hypertensive response to exercise] on structure and function of left ventricle (LV) has been reported consistently. Theoretically, individuals with HRE would be exposed to abnormally high pressure loads to left ventricle (LV), which may result in global subendocardial ischemia due to mismatch between demand and supply from excessive rate-pressure stress. Indeed, a previous study demonstrated a greater likelihood of new or worsening abnormalities of wall motions from echocardiography in individuals with HRE, even in the absence of angiographically significant coronary artery stenosis.

The issue is that you're confusing somewhat high blood pressure with abnormally high blood pressure during/after exercise, i.e.


Blood pressure is defined as the force of blood pushing against the walls of the arteries as the heart pumps blood. High blood pressure – also known as hypertension – is a disease in which blood flows through blood vessels (arteries) at a higher than normal pressure.

Blood pressure is measured with two numbers. The first, or top number, is the pressure in your blood vessels when your heart beats, called the systolic pressure. Systolic pressure is the higher of the two numbers. The second, or bottom number, measures the force of blood in your arteries while your heart is relaxed between beats. The bottom number is the lower of the two and is called the diastolic pressure.

Normal pressure is 120/80 or lower. Your blood pressure is considered high (stage 1) if it reads 130/80. Stage 2 high blood pressure is 140/90 or higher. If you get a blood pressure reading of 180/110 or higher more than once, seek medical treatment right away. A reading this high is considered “hypertensive crisis.”

Readings between 120/80 and 129/89 are considered pre-hypertension. People with pre-hypertension do not have blood pressure as low as it should be but are not yet considered to have high blood pressure.


Causes of high blood pressure and a low pulse

High blood pressure and a low pulse is a rare occurrence. Some medical conditions and medications can cause this condition to occur.

A person’s pulse rate, which indicates their heart rate, is how many times the heart beats per minute. Doctors usually consider a low pulse as less than 60 beats per minute. They call this bradycardia.

Blood pressure is the measure of the force of blood inside the blood vessels. High blood pressure can overload the circulatory system, increasing the risks for heart attack and stroke.

Most doctors consider high blood pressure as greater than 130/80, according to the new guidelines released by the American Heart Association.

Severely high blood pressure is pressure greater than 170/100.

In this article, we take a look at the possible causes of high blood pressure with a low pulse.

Share on Pinterest Some medical conditions or medications can cause high blood pressure and a low pulse.

Beta-blockers are a class of drugs that doctors sometimes prescribe to treat high blood pressure and reduce the effects of heart failure.

Examples of beta-blockers include:

  • atenolol (Tenormin)
  • metoprolol (Lopressor, Toprol XL)
  • nebivolol (Bystolic)
  • propranolol (Inderal)

These medicines work to block beta receptors in the heart. Stimulating these receptors increases heart rate while blocking them decreases heart rate.

A lower heart rate is beneficial for a person who has heart problems because it allows more time for the heart to fill. When the heart beats slower, it also requires less oxygen. This places less strain on the heart and “rests” the heart.

Doctors will sometimes prescribe beta-blockers to people who have high blood pressure, congestive heart failure, or a cardiac arrhythmia when the heart beats irregularly. For this reason, a person who already has high blood pressure can have a lower heart rate with beta-blockers.

Treatments

Doctors can also prescribe other medications to reduce blood pressure, including:

    channel blockers
  • angiotensin receptor blockers
  • angiotensin converting enzyme inhibitors

These drugs do not usually affect the heart rate while treating blood pressure.

The Cushing reflex is a rare occurrence that causes a low pulse and high blood pressure.

The reflex is the result of the body’s response to increased intracranial pressure. Intracranial pressure is the pressure inside the head and is a measurement of blood pressure in the brain.

The brain rests inside a person’s skull, so, if it swells, there is only so far it can expand. As a result, swelling causes intracranial pressure to increase.

The Cushing reflex is one of the body’s ways to try and keep pressure from getting too high in the skull. It signals receptors in the heart to slow the heart rate down to lower the intracranial pressure.

Severe medical conditions usually activate the Cushing reflex. These conditions include:

Treatments

The Cushing reflex is an emergency. Once doctors recognize this condition, their goal is to try and treat the cause and reduce the intracranial pressure in the brain. If the pressure gets too high, it can permanently damage the brain. A person can die from excessively high intracranial pressure.

A low pulse rate can sometimes be an indicator of a problem with the heart’s electrical conduction pathway.

The heart has an electrical system that travels in a distinct pattern to make the heart beat with a regular rhythm. If there is damage, scarring, or overstretching of the heart, the electrical system may not work as effectively. This can cause a low pulse rate.

Chronic high blood pressure can contribute to damage to the electrical system that, in turn, leads to a low pulse rate. Other causes of damage include smoking, a history of heavy drug or alcohol use, or aging of the heart.

Treatments

A person whose pulse suddenly seems to be slowing down for no known reason should see a doctor. This is especially true if they feel dizzy or short of breath.

On certain occasions, a person may require a pacemaker or other intervention, such as cardiac ablation, to repair the damaged electrical heart pathways.


Can Lack of Sleep Cause High Blood Pressure?

When most people think about high blood pressure, they might have the image of a poor, high salt diet and lack of exercise. And if that’s what you were thinking might be behind your high blood pressure, there’s a chance that you’re right.

Smoking, obesity, a sedentary lifestyle, excess sodium, and other factors, including chronic kidney disease and genetics also make you more susceptible to hypertension. But one thing that often gets ignored? Lack of sleep.

Sleep regulates hormones like cortisol–when people are chronically sleep deprived, the nervous system isn’t able to regulate these hormones which can lead to elevated blood pressure.

A study conducted by researchers at the University of Arizona last year found that even just one or a few poor nights of sleep could cause a sudden spike in blood pressure. The 300 men and women who participated did not have any known heart conditions and were monitored through the night. There was a positive correlation between sleeping less and higher blood pressure spikes during the night, building on other evidence just how important sleep is for our heart health.


  • Prehypertension: 120/80 to 139/89
  • STAGE 1 Mild Hypertension: 140/90 to 159/99
  • STAGE 2 Moderate Hypertension: 160/100 to 179/109
  • STAGE 3 Severe Hypertension: 180/110 or higher

Prehypertension stage can often be reversed by simple lifestyle modifications such as lower sodium diet, increased potassium and magnesium intake and more exercise.

While stages 1, 2 and 3 of hypertension are more critical, they too can still be reversed. The key with these is a strict nutritional therapy approach. We use combinations of supplements and diet and lifestyle changes targeted at lowering these numbers over time.

Keep reading for more information.


Stroke

There are two major types of strokes, ischemic and hemorrhagic (see illustration). Hemorrhagic strokes are less common but often cause the most dramatic symptoms. They occur when a blood vessel in the brain bursts, spilling blood into the brain or the fluid that surrounds it.

Ischemic strokes, which account for about 87% of all strokes, result when an artery that supplies blood to the brain becomes blocked by a clot. This can happen in either of two ways. In a thrombotic stroke, the clot forms in a diseased artery within the brain itself. In an embolic stroke, the clot forms outside the brain, then breaks away and is carried by the blood to the brain, where it lodges in a previously normal artery. Most emboli originate on atherosclerotic plaques in the carotid artery or aorta, or in the heart itself.

Each of these major types of strokes has a milder counterpart. Although major hemorrhagic strokes are impossible to overlook, MRI studies show that small microbleeds are much more common. Similarly, many people have tiny ischemic strokes, which are classified as lacunar strokes because of their small size. Although a simple microbleed or lacunar stroke is not likely to produce symptoms, a series of these events can produce major problems, including memory loss, or cognitive dysfunction (see below). According to American Heart Association estimates, more than 13 million Americans have had one or more of these "silent" strokes, which are particularly common in people over 60, especially if they have hypertension.

Types of stroke

Hemorrhagic stroke

  • 13% of strokes
  • Caused by ruptured blood vessels, followed by blood leaking into tissue
  • Usually more serious than ischemic stroke

Subarachnoid hemorrhage

  • Bleeding into the space between the brain and the skull
  • Develops most often from an aneurysm, a weakened, ballooned area in the wall of an artery
  • Severe headache is often the first symptom

Intracerebral hemorrhage

  • Bleeding from a blood vessel inside the brain
  • Often caused by high blood pressure and the damage it does to arteries

Ischemic stroke

  • 87% of strokes
  • Caused by blockages in brain blood vessels
  • Brain tissue dies when blood flow is blocked

Embolic stroke

  • Caused by emboli, blood clots that travel from elsewhere in the body to blood vessels in the brain
  • 60% of all strokes in Americans are embolic strokes 25% of embolic strokes are related to atrial fibrillation (an irregular heart rhythm)

Thrombotic stroke

Also known as atherothrombotic stroke


What Intense Training Does to Your Blood

Intense exercise can make routine blood numbers look like a health crisis. Save yourself worry (and expense) by knowing what to watch for.

Last year, 43-year-old Jay Ashman took a routine blood test the morning after a vigorous leg workout at Kansas City Barbell. A few days later, the former rugby player got a call from his doctor saying two key indicators of kidney function were abnormal.

&ldquoI went into panic mode,&rdquo he recalls. &ldquoI was thinking kidney failure, dialysis, dying early, all kinds of crap.&rdquo But additional testing determined his kidneys were normal. Heavy weightlifting had skewed the initial readings.

Abnormal blood-work results are actually a common issue among men who work out hard or compete in extreme events. That&rsquos because most lab reference ranges are based on the general population, not avid exercisers, explains Spencer Nadolsky, D.O., a board-certified family-medicine and obesity physician in Maryland. &ldquoYou need to look at labs in the context of each patient. Otherwise it can cause a lot of worry or excessive testing.&rdquo

There aren&rsquot any stats on how many athletic guys are affected, but more men than ever are exercising harder and harder. The number of half marathons is at an all-time high, more than 4.5 million people complete obstacle-course races annually, and experts say that high-intensity workouts are more popular than ever.

Frequent, intense, or sustained exercise can change your body from the inside out, which can raise red flags on routine blood tests. Here&rsquos what you need to know to protect yourself.

Don't Stress the White Coat

New research reveals that &ldquowhite-coat hypertension&rdquo &mdash the stress of being in a medical environment &mdash is not benign. It can be indicative of how your BP increases in response to stressful situations.

If you&rsquore among the estimated 30 percent of people whose BP usually spikes when they visit the GP, ask your doctor about wearing an ambulatory 24-hour monitor to record blood pressure throughout the day. This will provide the most accurate assessment.

Don&rsquot forget: The new normal for blood pressure is 120 systolic over 80 diastolic.

If You Lift Weights

. . . Then Your Creatinine May Be High

Normal range: 0.9 to 1.3 mg/dL

Normal change with strength training: 10 to 20 percent higher

  • What it is: Creatinine results from the breakdown of creatine phosphate in the muscles. Kidneys filter this waste product from the blood, but if they&rsquore not working properly, it can build up. (This is what happened to Ashman.)
  • Who&rsquos at risk: Lifters and guys with high muscle mass.
  • Why it rises: A well-muscled guy will naturally have more creatinine than a skinnier counterpart. Couple this with normal muscle breakdown from exercise (especially heavy weight training) and blood readings can spike. &ldquoThe more muscle you have, the more it will break down and increase creatinine levels,&rdquo says Dr. Nadolsky.
  • What to do: Tell your doctor if you&rsquove been lifting hard or packed on muscle since your last visit. If your number is above normal, skip the gym for a week and retest.
  • When to worry: If levels are consistently high and you have other risk factors for kidney disease (diabetes, high blood pressure, family history), consider a cystatin C test or an ultrasound.

That's Not All, Lifters

Your White-Blood-Cell Count May Also Be High

Normal range: 4,500 to 11,000 white blood cells per microliter

Normal change with strength training: Increase up to two thirds

  • What it is: White blood cells are vital to your immune system, fighting viruses and other invaders.
  • Who&rsquos at risk: Intense exercise stresses the immune system, causing a temporary spike in the white-blood-cell count. Research has revealed that a 35-minute eccentric-based quads workout raises it by around two thirds.
  • Why it rises: Probably an inflammatory response caused by muscle damage. White blood cells, particularly the first responders, arrive at an injury site to clear cellular debris and aid recovery.
  • What to do: Tell your doctor if an intense exercise session may be to blame. You won&rsquot have to wait too long to retest. Levels have been shown to return to the pre-exercise baseline within 24 hours.
  • When to worry: Counts above 17,000 cells per microliter that don&rsquot retreat after an exercise break can signal infection, inflammation, or even leukemia, says Brandee Waite, M.D., at UC Davis Medical Center, especially if you also have fever, chills, persistent fatigue, swollen glands, or easy bruising.

If You Do Crossfit

. . . Then Your Creatine Kinase May Be High

Normal range: 44 to 196 units/liter

Normal change with exercise: Up to five times the upper limit

  • What it is: Creatine kinase (CK) is an enzyme that aids muscle-cell function. Levels rise with muscle damage. Doctors often order the test to check for a condition called rhabdomyolysis (or rhabdo), which can be exercise-induced. By-products of muscle breakdown leak into the bloodstream and damage the kidneys.
  • Who&rsquos at risk: Elevated CK levels are commonly linked to high-intensity programs such as CrossFit, but regular strength training and running can raise them too. You&rsquore also at higher risk once you resume exercise after a hiatus or when trying something new, says Dr. Nadolsky.
  • Why it rises: Muscle damage from a workout is the usual cause, particularly if you were doing eccentric or &ldquonegative&rdquo moves like slow lowering from a pullup or bicep curl, or downhill running. This can result in tiny holes in the membranes surrounding muscle fibers, allowing CK to leak out.
  • What to do: Let your doctor know if heavy WODs may be to blame, and retest after an exercise break. Make sure to give your body enough time to clear excess CK. Research has shown that levels can remain elevated seven days after a weightlifting workout.
  • When to worry: CK levels ten times the upper limit can indicate rhabdo, says Dr. Nadolsky. Other symptoms include severe muscle soreness, weakness, swelling, and cola-colored urine.

If You're a Bodybuilder

. . . Then Your AST and ALT May Be High

Normal range: 10 to 40 units/liter for AST 9 to 46 units/liter for ALT

Normal change with exercise: Up to double the high end of normal levels

  • What they are: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are generally called liver enzymes. High levels can signal liver disease such as hepatitis.
  • Who&rsquos at risk: Bodybuilders
  • Why they rise: These enzymes aren&rsquot just in your liver. Smaller amounts, especially of AST, are also in your muscles, says Dr. Nadolsky. So when they break down due to exercise, you may see a spike.
  • What to do: Tell your doctor if you&rsquove been lifting heavy (weights where three reps is challenging). If your numbers are worrisome, take a hiatus for a week or two and retest.
  • When to worry: Levels more than two times the upper limit are unlikely to stem from exercise, says Dr. Waite. That can indicate liver disease, especially if you also have abdominal pain, digestive difficulties, or yellowing skin.

If You Run

. . . Then Your Red-Blood-Cell Count May Be High

Normal range: 4.5 million to 5.9 million cells per microliter

Normal change with running: About double the high end of normal

  • What it is: Red blood cells carry oxygen from the lungs to the rest of your body, and having too few of them can affect the amount of oxygen that reaches your tissues. This test tells you how many you have.
  • Who&rsquos at risk: Aerobic-endurance athletes tend to have higher counts than sedentary folk, says Dr. Waite.
  • Why it rises: It&rsquos an adaptation to assist your body with the stress of endurance exercise. &ldquoRunners&rsquo bodies respond to training by creating more red blood cells to carry oxygen to their muscles,&rdquo Dr. Waite explains.
  • What to do: Red-blood-cell life span is about 120 days, so a recheck after a couple weeks off isn&rsquot likely to make a difference, says Dr. Waite. Either stop running or drop to a very low- intensity level for a month or more to see if it declines.
  • When to worry: Counts above 11 million cells per microliter could signal bone-marrow issues such as cancer. Specialized blood tests can check cell size and shape.

If You Do Lots of Cardio

. . . Then Your Total Cholesterol May Be High

Normal range: Under 200 mg/dL

Normal change with cardio: Levels 200 or above, depending on HDL


Management and Treatment

What should I do if I have high blood pressure?

If you have been diagnosed with high blood pressure, you and your healthcare provider will talk about your target blood pressure. Your provider may suggest that you:

  • Check your own blood pressure regularly with a home blood pressure monitor. These electronic monitors are available at most pharmacies or online. .
  • Reach and maintain your best body weight.
  • Limit alcohol to no more than two drinks each day for men and less than one drink each day for women. One drink is defined as 1 oz. of alcohol, 5 oz. of wine, or 12 oz. of beer.
  • Be more physically active.
  • Quit smoking.
  • Work on controlling anger and managing stress.

What diet helps control high blood pressure?

  • Eat foods that are lower in fat, salt and calories, such as skim or 1% milk, fresh vegetables and fruits, and whole grain rice, and pasta. (Ask your doctor or healthcare provider for a more detailed list of low sodium foods to eat.)
  • Use flavorings, spices and herbs to make foods tasty without using salt. The optimal recommendation for salt in your diet is to have less than 1500 milligrams of sodium a day. Don't forget that most restaurant foods (especially fast foods) and many processed and frozen foods contain high levels of salt. Use herbs and spices that do not contain salt in recipes to flavor your food do not add salt at the table. (Salt substitutes usually have some salt in them.)
  • Avoid or cut down on butter and margarine, regular salad dressings, fatty meats, whole milk dairy products, fried foods, processed foods or fast foods, and salted snacks.
  • Ask your provider if you should increase potassium in your diet Discuss the Dietary Approaches to Stop Hypertension (DASH) diet with your provider. The DASH diet emphasizes adding fruits, vegetables, and whole grains to your diet while reducing the amount of sodium. Since it is rich in fruits and vegetables, which are naturally lower in sodium than many other foods, the DASH diet makes it easier to eat less salt and sodium.

What medications are used to treat high blood pressure?

Four classes of high blood pressure medications are considered “first line” (most effective and commonly prescribed) when starting treatment. Sometimes other medications are coupled with these first-line drugs to better control your high blood pressure. First-line drug pressure lowering medications are:

  • Angiotensin-converting enzyme (ACE) inhibitors block the production the angiotensin II hormone, which the body naturally uses to control blood pressure. When angiotensin II is blocked, your blood vessels don’t narrow. Examples: lisinopril (brand name Zestril®), enalapril (Vasotec®), captopril (Capoten®).
  • Angiotensin II receptor blockers (ARBs) block this same hormone from binding with receptors in the blood vessels. ARBs work the same way as ACE inhibitors to keep blood vessels from narrowing. Examples: metoprolol (brand names Lopressor® Toprol® XL), valsartan (Diovan®), losartan (Cozaar®).
  • Calcium channel blockers prevent calcium from entering the muscle cells of your heart and blood vessels, allowing these vessels to relax. Examples: amlodopine (brand name Norvasc®), nifedipine (Procardia®), diltiazem (Cardizem® Dilacor® XR Tiazac®).
  • Diuretics (water or fluid pills) flush excess sodium from your body, reducing the amount of fluid in your blood. Diuretics are often used with other high blood pressure medicines, sometimes in one combined pill. Examples: indapamide, hydrochlorothiazide, chlorothiazide.

Talk to your healthcare provider about what side effects and problems are possible when you take your blood pressure medicine. Some medications should be avoided during pregnancy. If you get side effects that concern you, call your provider. They may change your dose or try a different medication. Don’t stop taking the medicine on your own.


Venous System

The pumping action of the heart propels the blood into the arteries, from an area of higher pressure toward an area of lower pressure. If blood is to flow from the veins back into the heart, the pressure in the veins must be greater than the pressure in the atria of the heart. Two factors help maintain this pressure gradient between the veins and the heart. First, the pressure in the atria during diastole is very low, often approaching zero when the atria are relaxed (atrial diastole). Second, two physiologic “pumps” increase pressure in the venous system. The use of the term “pump” implies a physical device that speeds flow. These physiological pumps are less obvious.

Skeletal Muscle Pump

In many body regions, the pressure within the veins can be increased by the contraction of the surrounding skeletal muscle. This mechanism, known as the skeletal muscle pump (Figure 6), helps the lower-pressure veins counteract the force of gravity, increasing pressure to move blood back to the heart. As leg muscles contract, for example during walking or running, they exert pressure on nearby veins with their numerous one-way valves. This increased pressure causes blood to flow upward, opening valves superior to the contracting muscles so blood flows through. Simultaneously, valves inferior to the contracting muscles close thus, blood should not seep back downward toward the feet. Military recruits are trained to flex their legs slightly while standing at attention for prolonged periods. Failure to do so may allow blood to pool in the lower limbs rather than returning to the heart. Consequently, the brain will not receive enough oxygenated blood, and the individual may lose consciousness.

Figure 6. The contraction of skeletal muscles surrounding a vein compresses the blood and increases the pressure in that area. This action forces blood closer to the heart where venous pressure is lower. Note the importance of the one-way valves to assure that blood flows only in the proper direction.

Respiratory Pump

The respiratory pump aids blood flow through the veins of the thorax and abdomen. During inhalation, the volume of the thorax increases, largely through the contraction of the diaphragm, which moves downward and compresses the abdominal cavity. The elevation of the chest caused by the contraction of the external intercostal muscles also contributes to the increased volume of the thorax. The volume increase causes air pressure within the thorax to decrease, allowing us to inhale. Additionally, as air pressure within the thorax drops, blood pressure in the thoracic veins also decreases, falling below the pressure in the abdominal veins. This causes blood to flow along its pressure gradient from veins outside the thorax, where pressure is higher, into the thoracic region, where pressure is now lower. This in turn promotes the return of blood from the thoracic veins to the atria. During exhalation, when air pressure increases within the thoracic cavity, pressure in the thoracic veins increases, speeding blood flow into the heart while valves in the veins prevent blood from flowing backward from the thoracic and abdominal veins.

Pressure Relationships in the Venous System

Although vessel diameter increases from the smaller venules to the larger veins and eventually to the venae cavae (singular = vena cava), the total cross-sectional area actually decreases. The individual veins are larger in diameter than the venules, but their total number is much lower, so their total cross-sectional area is also lower.

Also notice that, as blood moves from venules to veins, the average blood pressure drops, but the blood velocity actually increases. This pressure gradient drives blood back toward the heart. Again, the presence of one-way valves and the skeletal muscle and respiratory pumps contribute to this increased flow. Since approximately 64 percent of the total blood volume resides in systemic veins, any action that increases the flow of blood through the veins will increase venous return to the heart. Maintaining vascular tone within the veins prevents the veins from merely distending, dampening the flow of blood, and as you will see, vasoconstriction actually enhances the flow.

The Role of Venoconstriction in Resistance, Blood Pressure, and Flow

As previously discussed, vasoconstriction of an artery or arteriole decreases the radius, increasing resistance and pressure, but decreasing flow. Venoconstriction, on the other hand, has a very different outcome. The walls of veins are thin but irregular thus, when the smooth muscle in those walls constricts, the lumen becomes more rounded. The more rounded the lumen, the less surface area the blood encounters, and the less resistance the vessel offers. Vasoconstriction increases pressure within a vein as it does in an artery, but in veins, the increased pressure increases flow. Recall that the pressure in the atria, into which the venous blood will flow, is very low, approaching zero for at least part of the relaxation phase of the cardiac cycle. Thus, venoconstriction increases the return of blood to the heart. Another way of stating this is that venoconstriction increases the preload or stretch of the cardiac muscle and increases contraction.


Pseudo-resistant (seemingly resistant) hypertension is high blood pressure that seems to be resistant to treatment, but other factors are actually interfering with proper treatment or measurement. Specifically:

  • Wrong medication or wrong dose
  • Medicines and supplements
  • Lifestyle factors
  • White-coat effect
  • Stiffening of the arteries
  • Inadequate measurement technique

Pseudo-resistant hypertension is also very important to diagnose as true resistant hypertension, because both conditions raise your risk of heart attack and stroke.

Wrong Medication or Wrong Dose

For each person there’s an ideal combination of medications and dosages that would best control their hypertension. Some people haven’t yet received that ideal combination. It’s important to work with a doctor who is familiar with the range of medications and who knows what works best for each individual.

Medicines and Supplements

Many medications and supplements raise blood pressure. Examples include various pain medications, antidepressants, decongestants, aspirin at high doses and birth control pills. Stimulants — from caffeine and ADHD medications to cigarettes — as well as recreational drugs and excessive alcohol can also raise blood pressure. So can many “natural” or “herbal” supplements, as well as licorice-containing candies or drinks.

It’s important to give your doctor the full picture of the medicines and supplements you take, whether you take them every day or just once in a while.

Lifestyle Factors

Your lifestyle can make high blood pressure hard to control or may have caused it in the first place. Taking blood pressure medications without changing your habits means your medicine is lowering your blood pressure while your actions raise it back up. Such actions may include:

  • Skipping your medication: When you take an aspirin and your headache goes away, you know the aspirin is working. But hypertension doesn’t cause any symptoms, so you may be less motivated to take your blood pressure medications every day, allowing your body to suffer the damage caused by high blood pressure over time.
  • Eating too much sodium (salt): Sodium raises blood pressure. Most Americans get too much salt from processed foods. Learn simple steps to reduce the salt in your diet. : Smoking narrows and hardens your arteries, raising blood pressure. Consult your physician about how to quit smoking.
  • Sitting around: Exercise strengthens your heart, allowing it to pump more blood with less effort. The good news: 40 minutes of aerobic exercise four times a week may lower your blood pressure as much as some medications do.
  • Drinking too much alcohol. Alcoholic beverages raises blood pressure if they are consumed frequently.

White-Coat Effect

Many people have higher blood pressure in the doctor’s office than they have during their regular day. If your doctor suspects white-coat effect, you may need to wear a small, portable, 24-hour blood pressure monitor to see what your pressure looks like over time during your daily activities, or measure or BP with an automated device at home.

Stiffening of the Arteries

Some physicians consider the most authentic form of pseudo-resistant hypertension to be caused by stiffened brachial (arm) arteries that prevent the blood pressure cuff from obtaining a true reading. If your doctor suspects this form of pseudo-resistant hypertension, they might consider other ways to measure your blood pressure.

Inadequate Measurement Technique

Though it sounds simple, blood pressure can be measured incorrectly, and home blood pressure devices may not be properly calibrated. Your health care provider must take several factors into consideration, such as the size of your arm and your body’s position during measurement.