Diagnosing Resistant Hypertension: Tools, Triggers, and Screening Tactics

The diagnostic evaluation of resistant hypertension requires a systematic approach that begins with comprehensive lifestyle assessment rather than immediate medication adjustments. Dr Cohen emphasizes the importance of detailed dietary history, including specific questions about recent meals, cooking responsibilities, and sodium intake patterns. This investigative approach often reveals hidden sources of dietary sodium and family dynamics that may undermine treatment effectiveness, providing crucial insights into apparent treatment resistance.

Patient access to medications and adherence capabilities form critical components of resistant hypertension diagnosis. Health care providers must evaluate whether patients have reliable access to prescribed medications, adequate time for consistent dosing schedules, and the organizational skills necessary for complex medication regimens. Many patients juggle multiple jobs, family responsibilities, and other life stressors that can significantly impact their ability to maintain consistent treatment adherence, making these social determinants essential diagnostic considerations.

The white coat effect presents a significant diagnostic challenge in resistant hypertension evaluation, requiring careful differentiation between office-based blood pressure elevation and true hypertensive episodes. Dr Cohen recommends having patients bring their home monitoring devices to clinic visits for calibration and comparison. This approach helps distinguish between situational anxiety responses and genuine stress-induced hypertension, which may indicate underlying cardiovascular reactivity that requires different therapeutic approaches than simple white coat syndrome.