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Causes of Inadequate Responsiveness to Therapy Pseudoresistance ■ “White-coat hypertension” or office elevations ■ Pseudohypertension in older patients ■ Use of regular adult cuff on a very obese arm Nonadherence to therapy Volume overload ■ Excess salt intake ■ Progressive renal damage (nephrosclerosis) ■ Fluid retention from reduction of blood pressure ■ Inadequate diuretic therapy Drug-related causes ■ Doses too low ■ Wrong type of diuretic ■ Inappropriate combinations ■ Rapid inactivation (e.g., hydralazine) ■ Drug actions and interactions ■ Sympathomimetics ■ Nasal decongestants ■ Appetite suppressants ■ Cocaine and other illicit drugs ■ Caffeine ■ Oral contraceptives ■ Adrenal steroids ■ Licorice (as may be found in chewing tobacco) ■ Cyclosporine or tacrolimus ■ Erythropoietin ■ Antidepressants ■ Nonsteroidal anti-inflammatory drugs Associated conditions ■ Smoking ■ Increasing obesity ■ Sleep apnea ■ Insulin resistance or hyperinsulinemia ■ Ethanol intake of more than 1 oz (30 mL) per day ■ Anxiety-induced hyperventilation or panic attacks ■ Chronic pain ■ Intense vasoconstriction (arteritis) ■ Organic brain syndrome (e.g., memory deficit) Identifiable causes of hypertension Adapted from JNC-7 Express, National Heart, Lung, and Blood Institute