Hypertension that remains >140/90mmHg despite the use of 3 antihypertensive drugs in a rational combination at full doses and including a diuretic i.e. thiazide.

Management

• Consider and correct all correctable causes before referral: poor adherence, wrong BP technique or cuff size, white-coat effect, inadequate doses, excess salt or alcohol, volume overload, interacting medicines (NSAIDs, oestrogen contraceptives, steroids) and secondary causes (kidney disease, endocrine causes, sleep apnoea).

• Refer to a specialist when resistant hypertension persists after this review.