Abstract
Resistant hypertension is associated with substantial cardiovascular, cerebrovascular, and renal risk and requires careful confirmation before therapy is intensified. In Canada, the 2025 Hypertension Canada primary care guideline defines hypertension as blood pressure (BP) >=130/80 mm Hg when measured under optimal conditions and generally recommends a systolic BP target <130 mm Hg when tolerated. True resistant hypertension should be considered when BP remains above target despite adherence to maximally tolerated therapy with an ACE inhibitor or angiotensin receptor blocker (ARB), a thiazide or thiazide-like diuretic, and a long-acting dihydropyridine calcium-channel blocker. Management requires exclusion of pseudoresistance, assessment for secondary causes, optimization of diuretic therapy, and usually addition of spironolactone as fourth-line treatment when renal function and potassium permit. From the physician perspective, priorities include confirming the diagnosis, evaluating secondary hypertension and comorbidity, individualizing treatment, and distinguishing chronic resistance from hypertensive emergency. Clinical pharmacists complement this work through medication reconciliation, adherence assessment, identification of BP-raising drugs, dose optimization, laboratory monitoring, patient education, and post-discharge follow-up. A coordinated physician-pharmacist model can strengthen Canadian hypertension care while reducing both undertreatment and avoidable overtreatment.
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Ethics & Declarations
Author Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. All authors read and approved the final manuscript.
Ethics Approval and Consent to Participate
Not applicable. This study did not involve human participants, animal experimentation, or confidential patient clinical data.
Consent for Publication
Not applicable, or informed consent for publication was obtained from all individual participants where relevant.
Competing Interests
The authors declare that they have no competing financial or non-financial interests.
Funding
The authors declare that no funds, grants, or other financial support were received during the preparation of this manuscript.
Data Availability Statement
Data sharing is not applicable to this article as no new datasets were generated or analyzed during the current study.
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© 2026 Francis Stewart et al. International Journal of Clinical Pharmacy and Medicine.