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Why does blood pressure not go down after taking medication?

High blood pressure, also known as hypertension, is a common condition that can lead to serious health complications if left untreated. Many people with high blood pressure take medication to help lower their blood pressure and reduce their risk of problems like heart attack and stroke. However, some people find that their blood pressure doesn’t seem to go down, even after taking blood pressure medication.

What Causes High Blood Pressure?

Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood through the body. High blood pressure develops when the pressure against the artery walls is too high.

There are two numbers in a blood pressure reading: systolic and diastolic. Systolic is the top number and represents pressure in the arteries when the heart beats. Diastolic is the bottom number and measures pressure between heartbeats.

Blood pressure is considered high when readings consistently range at or above 140 mm Hg systolic or 90 mm Hg diastolic.

Blood Pressure Category Systolic Diastolic
Normal Less than 120 Less than 80
Elevated 120-129 Less than 80
Stage 1 Hypertension 130-139 80-89
Stage 2 Hypertension 140 or higher 90 or higher

There are often no obvious symptoms of high blood pressure. Some people may experience headaches, shortness of breath, or nosebleeds, but many have no signs or symptoms at all.

What Causes High Blood Pressure?

There are a few factors that can contribute to high blood pressure:

  • Age – Blood pressure tends to increase with age as arteries stiffen.
  • Genetics – Some people inherit genes from their parents that increase their risk.
  • Weight – Being overweight or obese can put extra pressure on arteries.
  • Sodium intake – Eating too much sodium can cause fluid retention, increasing blood pressure.
  • Stress – High levels of stress hormones can lead to constricted blood vessels.
  • Smoking – Chemicals in tobacco smoke can damage blood vessels.
  • Alcohol – Drinking too much alcohol can cause heart damage and spikes in blood pressure.
  • Physical inactivity – Not getting enough exercise makes the heart work harder to pump blood.

Certain medical conditions like kidney disease, diabetes, and sleep apnea can also lead to hypertension. Some medications like steroids, birth control pills, decongestants, and NSAIDs may also raise blood pressure.

How Do Blood Pressure Medications Work?

There are many different types of blood pressure medications that lower pressure in different ways:

  • Diuretics remove excess fluid and sodium from the body to relax blood vessels.
  • ACE inhibitors block a chemical that narrows blood vessels to allow blood to flow more easily.
  • ARBs block a hormone that causes blood vessels to constrict.
  • Beta-blockers reduce heart rate and force of contraction to lower blood pressure.
  • Calcium channel blockers prevent calcium from entering heart and blood vessel cells to relax muscles.
  • Alpha-blockers reduce nerve impulses to blood vessels, allowing blood to pass more easily.
  • Vasodilators relax blood vessel muscles to expand blood vessels and improve flow.
  • Nervous system inhibitors prevent overactivity of the sympathetic nervous system to relax blood vessels.

Doctors may prescribe one or a combination of these medications to help control high blood pressure.

Why Might Blood Pressure Not Decrease With Medication?

There are several possible reasons why some people may not experience a drop in blood pressure after beginning medication:

Incorrect Dosage

If the medication dose is too low, it may not be enough to adequately lower blood pressure. Doctors usually start with a low dose and gradually increase it over several weeks to reach optimal therapeutic effects while minimizing side effects.

It can take some trial and error to find the appropriate dosage that works for each individual patient. Speaking with a doctor about increasing the medication dose or adjusting the prescription may help get blood pressure into a healthy range.

Ineffective Medication

Some people may not respond as well to certain blood pressure medications due to the way their body metabolizes the drug. Others may develop a tolerance over time.

In these cases, the doctor may recommend switching to a different medication or adding a second drug to create a more effective combination. Finding the right medication or combination can take some patience through trial and error.


Not taking blood pressure medication as prescribed is one of the most common reasons it may not work effectively. This includes:

  • Forgetting to take doses
  • Stopping the medication due to side effects
  • Taking lower doses than prescribed
  • Not refilling prescriptions on time

Adherence is crucial for blood pressure medications to work properly. Setting phone alarms, linking dosing to a daily routine, using pill organizers, and speaking with a doctor about side effects can improve adherence.

Underlying Medical Conditions

Sometimes other uncontrolled medical problems may interfere with blood pressure control, such as:

  • Untreated sleep apnea putting stress on the cardiovascular system
  • Undiagnosed thyroid dysfunction affecting heart rate and blood pressure
  • Uncontrolled diabetes damaging blood vessels
  • Chronic kidney disease preventing proper fluid excretion

Treating these kinds of conditions may help improve blood pressure response. Doctors should investigate for any underlying issues that could undermine treatment.

Blood Pressure Measurement Errors

Errors in measuring blood pressure could make it appear that readings are not decreasing when they actually are. This includes:

  • Using inaccurate blood pressure monitors
  • Cuff is wrong size for the arm
  • Measuring too soon after eating, drinking caffeine, or exercise
  • Talking or moving arm during measurement
  • Measuring only once instead of taking multiple readings

Proper blood pressure monitoring technique is vital for tracking treatment progress accurately.

Weight Gain or Lifestyle Factors

Gaining excess weight, adopting a high-sodium diet, drinking more alcohol, or leading a sedentary lifestyle can all undermine the effects of blood pressure medication. Maintaining healthy lifestyle habits is key.

Secondary Hypertension

In about 5-10% of high blood pressure cases, the cause is due to an underlying medical condition or other factor rather than lifestyle, genetics, or aging. This is called secondary hypertension.

Causes of secondary hypertension include:

  • Obstructive sleep apnea
  • Kidney problems
  • Thyroid issues
  • Adrenal gland tumors
  • Congenital defects in blood vessels
  • Certain medications
  • Illegal drugs
  • Alcohol abuse

Doctors should investigate for these types of causes if blood pressure remains uncontrolled after trying lifestyle changes and multiple medications.

Tips for Improving Blood Pressure Treatment

If your blood pressure is not decreasing after beginning medication, try these tips:

  • Carefully follow medication instructions and refill prescriptions on time
  • Use reminders and pill organizers to avoid forgotten doses
  • Monitor blood pressure regularly with good technique
  • Discuss adjusting medication dose or prescription with your doctor
  • Have potential underlying conditions evaluated
  • Adopt lifestyle changes like a healthy diet, exercise, and stress management
  • Avoid medications, supplements, alcohol and salt that may raise blood pressure
  • Be patient – Finding optimal treatment can take some time

Most importantly, maintain open communication with your healthcare provider. Tracking your blood pressure readings and reporting your medication response and side effects will help guide treatment decisions.

Seeking care from hypertension specialists if blood pressure remains uncontrolled can also provide more focused treatment options to help protect your heart, brain, and kidneys.

The Bottom Line

There are many potential reasons why blood pressure may not decrease after beginning medication, including inadequate dosing, ineffective medication choice, underlying medical conditions, inaccurate measurement, or lifestyle habits undermining treatment.

Work closely with your doctor to review your treatment regimen, adjust prescriptions accordingly, rule out any secondary causes, and optimize your adherence and lifestyle habits for the best chance of successfully lowering your blood pressure.

While frustrating, uncontrolled hypertension despite medication is a common obstacle doctors see. Be patient, persistent, and proactive with the help of your healthcare team to find the right solutions to control your blood pressure and reduce your risk of complications.