| Non-adherence to therapy |
• Instructions not understood |
| • Side effects |
| • Cost of medication and/or cost of attending at
healthcare centre |
| • Lack of consistent and continuous primary care |
| • Inconvenient and chaotic dosing schedules |
| • Organic brain syndrome (e.g. memory deficit) |
| Volume overload |
• Excess salt intake |
| • Inadequate diuretic therapy |
| • Progressive renal damage (nephrosclerosis) |
| Associated conditions |
• Smoking |
| • Increasing obesity |
| • Sleep apnoea |
| • Insulin resistance/hyperinsulinaemia |
| • Ethanol intake of more than 30 g (three standard
drinks) daily |
| • Anxiety-induced hyperventilation or panic
attacks |
| • Chronic pain |
| • Intense vasoconstriction (Raynaud’s phenomenon),
arteritis |
| Identifiable causes of hypertension |
• Chronic kidney disease |
| • Renovascular disease |
| • Primary aldosteronism |
| • Coarctation |
| • Cushing’s syndrome |
| • Phaeochromocytoma |
| Pseudoresistance |
• ‘Whitecoat hypertension’ or office elevations |
| • Pseudohypertension in older patients |
| • Use of regular cuff in obese patients |
| Drug-related causes |
• Doses too low |
| • Wrong type of diuretic |
| • Inappropriate combinations |
| • Rapid inactivation (e.g. hydralazine) |
| Drug actions and interactions |
• Non-steroidal anti-inflammatory drugs (NSAIDs) |
| • Sympathomimetics: nasal decongestants, appetite
suppressants |
| • Cocaine, Tik and other recreational drugs |
| • Oral contraceptives |
| • Adrenal steroids |
| • Liquorice (as may be found in chewing tobacco) |
| • Cyclosporine, tacrolimus, erythropoietin |
| • Antidepressants (monoamine oxidase inhibitors,
tricyclics) |
