Review Article

Resistant Hypertension Workup and Approach to Treatment

Table 1

Causes of resistant hypertension.

Exogenous substances
Drug related (see Table 2)
Herbal  preparations  (licorice,  ephedra,  ginseng,  yohimbine,  ma huang,  and bitter  orange)
Alcohol consumption
Excess sodium intake

Concomitant conditions
Obesity
Insulin resistance
Smoking

Pseudoresistance
White-coat hypertension
Pseudohypertension in the elderly
Measurement artifact
Physician inertia

Secondary causes of hypertension
(i) Common causes
Renovascular disease
Renal parenchymal disease
Primary aldosteronism
Pheochromocytoma
Cushing syndrome
Thyroid and parathyroid disease
Coarctation of the aorta
(ii) Rare causes
Aneurysm located at the bifurcation of the right  renal artery
Arterial thrombosis from abdominal aorta to both  common iliac  arteries
Occlusion of the left renal artery
Hypercalcemia
Carcinoid syndrome
Central nervous system tumors
Premenstrual syndrome