Why Blood Pressure Won't Budge—and How Pharmacists Help

In an interview with Pharmacy Times, Stacey M. Cutrell, PharmD, BCACP, CDCES, a clinical pharmacist practitioner in the family medicine department at UNC Health, discussed where blood pressure targets for patients with diabetes now stand and the most common medication-related reasons blood pressure fails to improve. The discussion was based on a presentation by Cutrell at the Association of Diabetes Care and Education Specialists 2026 Annual Meeting in Columbus, Ohio, titled “When Blood Pressure Won’t Budge: Managing Resistant Hypertension in People with Diabetes.”

On targets, Cutrell said current guidance calls for most adults with confirmed hypertension to aim for less than 130/80 mmHg, while patients with increased cardiovascular risk should aim for a systolic pressure below 120 to reduce cardiovascular mortality and morbidity. She acknowledged that, particularly in patients with diabetes, historic data were conflicting—intensive treatment did not always show a significant reduction in cardiovascular outcomes versus standard treatment—but noted that newer data and robust meta-analyses now favor the more intensive systolic target below 120. Cutrell characterized the evidence for a less than 130/80 goal as quite strong, with even stronger support for a below-120 target in high-risk patients, including those with established cardiovascular disease, diabetes, chronic kidney disease, or heart failure. She emphasized individualizing targets based on tolerability, kidney function, orthostasis, and other adverse events.

On why blood pressure won't budge, Cutrell pointed first to pseudo-resistance driven by medication behaviors and non-adherence, urging pharmacists to ask open-ended questions, review pharmacy dispense reports, and support adherence with tools like pill boxes and alarms. She highlighted the guideline emphasis on single-pill combination products to reduce pill burden. Cutrell also stressed confirming that patients are on an optimized, first-line regimen at maximally tolerated doses, and—specific to resistant hypertension—considering a switch from hydrochlorothiazide to chlorthalidone, which she noted has a longer duration and more potent blood pressure–lowering effect, before adding another agent. For pharmacists, these steps offer concrete ways to intervene before escalating therapy.

You can watch part 1 of Stacey Cutrell’s interview with Pharmacy Times here.