Long-term and effective control of blood pressure is crucial to the prognosis of patients. However, in the process of treatment, we found that many hypertensive patients reflected: after taking a lot of drugs, blood pressure control is not ideal, either can not be lowered, or high and low. What is going on here? Reason one: the white coat effect. Some people are nervous when they see a doctor, blood pressure also rose, even after taking antihypertensive drugs, but also does not help, the doctor a measure of blood pressure is high. This part of the “patient” at home self-measurement blood pressure is normal, 24-hour ambulatory monitoring of blood pressure is also within the normal range. This kind of hypertension is medically known as “white coat hypertension”, which is obviously a kind of pseudo-hypertension. Countermeasure: Remove mental tension through psychological guidance. Because it is not true hypertension, no medication is needed. Reason 2: Neglect of non-pharmacological treatment. It is now known that in addition to genetics, hypertension is also associated with a poor lifestyle. Mental stress, excessive salt consumption, smoking and alcohol abuse, lack of exercise, and being overweight can all lead to higher blood pressure and reduce the effectiveness of antihypertensive drugs. Countermeasures: Improve lifestyle, which is often referred to as “non-drug therapy”, including a reasonable diet, moderate exercise, smoking and alcohol cessation, and psychological balance. In terms of diet, it should be low in salt (no more than 5~6 grams per day), low in fat, and increase the intake of potassium and calcium, and preferably choose aerobic exercises (such as brisk walking, jogging, swimming, cycling, etc.), but not strenuous exercises. Cause 3: Improper use of drugs. These include: insufficient drug dosage, small dose; single drug is not effective, not to take the combination of drugs; do not understand the half-life of drug metabolism, taking too long intervals; poor compliance with medication, often missed or not adhere to long-term treatment; the antagonistic effect of other drugs, such as sympathomimetic drugs in ephedrine, non-steroidal anti-inflammatory drugs such as anti-inflammatory pain, ibuprofen, birth control pills, glucocorticoids, etc. itself have elevated blood pressure If they are used in combination with antihypertensive drugs, the efficacy of the latter will be greatly reduced. Countermeasures: Follow the principle of individualized medication, start with a small dose of a single drug, gradually increase the amount, and if the effect is still not satisfactory, consider the combination of different types of antihypertensive drugs. Advocate the use of long-acting preparations, pay attention to the rational combination of drugs. Reason 4: The impact of kidney damage on hypertension treatment. Studies have confirmed that long-term hypertension can lead to small renal artery sclerosis, resulting in reduced renal blood flow and damage; renal damage in turn can aggravate hypertension, forming a vicious circle, making antihypertensive treatment difficult. Countermeasures: Adjust and improve renal function, choose antihypertensive drugs that have a protective effect on the kidneys, such as angiotensin-converting enzyme inhibitors Kepone and Lortin, and calcium antagonists such as Bexin, and also use diuretics such as dihydrocortisone to reduce water and sodium retention. It is important to emphasize that treatment of hypertension must begin early and be consistent, only then can we minimize the damage to target organs from hypertension. Cause 5: Secondary hypertension is not treated for its cause. Secondary hypertension accounts for about 5% of all hypertensive patients, the age of onset is relatively young, are caused by some specific causes, there are two common categories, namely renal hypertension caused by acute and chronic nephritis, renal cysts, renal artery stenosis, etc., endocrine hypertension caused by pheochromocytoma, primary aldosteronism, cortisolism, hyperthyroidism, etc.. Secondary hypertension often has high blood pressure for a long time, and drug treatment is difficult to be effective. Countermeasure: If the cause is clearly identified and completely eliminated (including surgical treatment), blood pressure can return to normal. Of course, in some cases, the original cause cannot be cured because of the specific lesion, and blood pressure is difficult to control. Cause 6: The quality of the drug itself is problematic. Such as expired, deteriorated and counterfeit drugs, the patient took not only can not play a therapeutic role, but also cause adverse reactions. Countermeasures: raise awareness of self-protection, go to a regular hospital, completely eliminate counterfeit and shoddy drugs, but of course, the joint efforts of the administrative and law enforcement departments and the whole society.