Comorbidities and Diagnostic Pitfalls of resistant hypertension

Assessment and Measurement Challenges

The first and most important step in managing hypertension is obtaining an accurate and reliable assessment of true blood pressure. Blood pressure measurement in medical offices presents several challenges, including the "white coat reaction" where patients experience nervousness that artificially elevates their readings. This necessitates measuring blood pressure both in and outside the office setting.

Incorporating home blood pressure monitoring and ambulatory blood pressure monitoring is crucial to identify white coat hypertension and distinguish it from sustained hypertension. These methods also help recognize masked hypertension, where blood pressure is actually lower in the office than during daily activities.

Recognizing and managing comorbidities or risk factors of resistant hypertension is essential, as these often drive elevated blood pressure levels. Treating these underlying conditions helps improve overall blood pressure control. Weight management is particularly important—reducing weight and decreasing BMI makes blood pressure control significantly easier to achieve.