Sometimes blood pressure stays high even after doing many of the right things. Doctors call this resistant hypertension.

What is resistant hypertension?

• Blood pressure stays high despite three different medicines (and one is usually a diuretic), or
• Your numbers are controlled but you need four or more medicines to do it.

First, rule out “false resistance”

• White coat effect: High in the clinic, normal at home. Use home logs or 24-hour monitoring.
• Wrong cuff: A small cuff can fake a high result.
• Missed doses: Life happens—set reminders or use a pill box.
• Other products: Decongestants, some pain meds (like certain NSAIDs), some herbal stimulants, and heavy alcohol can raise BP.

Check for common medical causes

Only your doctor can test for these:

• Sleep apnea
• Kidney problems
• Hormone issues (like extra aldosterone)
• Thyroid problems
• Narrowing of kidney arteries

Smart testing

• Home or ambulatory monitoring to confirm real-life numbers.
• Basic labs to look at kidneys and electrolytes.
• Sleep study if you snore, gasp, or feel very sleepy in the day.

Non-drug steps that actually help

• Sodium cutback: Big wins come from simple swaps—low-sodium broth, fewer packaged foods, fresh or frozen veggies, and rinsing canned beans.
• Weight loss if needed: Even 5–10 pounds can help.
• Alcohol breaks: Aim for several dry days each week.
• Better sleep: Regular schedule; treat sleep apnea if present.
• Exercise mix:
  • Aerobic most days (walks count).
  • Strength 2–3 days/week.
  • Isometric handgrip training 3–5 days/week in short, guided bouts that are easy on joints.

A weekly rhythm you can keep

• Mon/Wed/Fri: 25-minute walk + 8 minutes handgrip.
• Tue/Thu: Light body-weight moves (squats to a chair, wall push-ups) + 8 minutes handgrip.
• Weekend: One longer walk or bike ride, gentle stretching, meal prep.

Get support

• Bring your home log to visits.
• Ask about once-daily meds and combo pills to simplify schedules.
• If you have side effects, speak up—there are options.

The bottom line

Resistant hypertension has fixable pieces. Confirm the real numbers, look for hidden causes, and stack simple, proven habits—including guided isometric handgrip training—on top of your doctor’s plan.