Why uncontrolled hypertension needs a closer look
29 Sep 2026
For GPs, confirming the diagnosis is an important first step before deciding whether treatment needs to change. Blood pressure measured in the clinic can be affected by factors such as white-coat hypertension, where readings rise in a medical setting, or masked hypertension, where readings are normal in the clinic but higher outside it.
Australian guidance recommends confirming raised clinic readings rather than relying on a single measurement.
Ambulatory blood pressure monitoring (ABPM) can provide a fuller picture by recording blood pressure over 24 hours, including during the day and at night. It remains an important tool for confirming and classifying hypertension.
Home monitoring can also help patients track their blood pressure between appointments and support ongoing follow-up.
The way blood pressure is measured can also affect the result. Using the correct cuff size, a validated automated device, allowing the patient to rest before testing and taking repeated readings can help reduce measurement errors.
Masked hypertension should also be considered when a patient's clinic readings appear acceptable but their cardiovascular risk or signs of organ damage suggest otherwise.
ABPM can provide additional information about night-time blood pressure and whether blood pressure falls during sleep. These patterns can provide useful information when assessing cardiovascular risk.
Once high blood pressure has been confirmed, treatment may also need to be reviewed regularly. A delay in increasing or changing treatment can leave some patients with blood pressure above their target for longer than necessary.
Treatment decisions should consider the patient's overall cardiovascular risk rather than blood pressure readings alone.
For patients whose blood pressure remains high despite treatment, GPs need to determine whether the hypertension is truly resistant or whether another factor is contributing.
Possible factors include an unsuitable treatment plan, missed medicines, NSAID use, high salt or alcohol intake, obesity, obstructive sleep apnoea, chronic kidney disease and primary aldosteronism.
Before diagnosing resistant hypertension, out-of-office blood pressure measurements, a review of medicines and adherence, and assessment for possible secondary causes may be needed.
Treatment options are also continuing to develop. Renal denervation (RDN) may be considered for some patients with ongoing uncontrolled or resistant hypertension despite optimised treatment.
Recent sham-controlled trials have found that RDN can produce reductions in both ambulatory and clinic blood pressure in selected patients. However, it is not a first-line treatment and does not replace lifestyle measures or medicines.
For GPs, accurate assessment remains central to managing hypertension. This includes confirming blood pressure levels, reviewing treatment when control is not achieved, checking for factors that may be contributing and referring patients for specialist assessment when appropriate.
Why uncontrolled hypertension needs a closer look
Source: RACGP newsGP