Which factor could contribute to persistent hypertension despite medication titration?

Persistent hypertension despite medication titration can often be influenced by various factors, and in this scenario, the role of NSAIDs is significant. Nonsteroidal anti-inflammatory drugs (NSAIDs) can contribute to hypertension due to their effects on renal function and fluid retention. They inhibit the production of prostaglandins, which play a crucial role in maintaining adequate renal blood flow and glomerular filtration. This inhibition can lead to sodium and water retention, increasing blood volume and ultimately raising blood pressure.

Moreover, NSAIDs can interfere with the effectiveness of antihypertensive medications, particularly diuretics and ACE inhibitors. This interaction can complicate blood pressure management, making it more challenging to achieve target levels even when medications are carefully adjusted.

In contrast, while excessive sodium intake is a recognized risk factor for hypertension, it is often a lifestyle choice rather than a pharmacological influence. Diuretics typically aid in lowering blood pressure by promoting sodium and water excretion, thus they would not contribute to persistent hypertension. Statins are primarily used to manage cholesterol levels and have a neutral to beneficial effect on blood pressure, making them unlikely contributors to sustained hypertension. Thus, NSAIDs stand out as a critical factor that can lead to persistent hypertension in patients undergoing treatment.