Nature 575 , 7586 (2019)

Causes of Inadequate Responsiveness to Therapy Pseudoresistance White-coat hypertension or office elevations Pseudohypertension in older patients Use of regular adult cuff on a very obese arm Nonadherence to therapy Volume overload Excess salt intake Progressive renal damage (nephrosclerosis) Fluid retention from reduction of blood pressure Inadequate diuretic therapy Drug-related causes Doses too low Wrong type of diuretic Inappropriate combinations Rapid inactivation (e.g., hydralazine) Drug actions and interactions Sympathomimetics Nasal decongestants Appetite suppressants Cocaine and other illicit drugs Caffeine Oral contraceptives Adrenal steroids Licorice (as may be found in chewing tobacco) Cyclosporine or tacrolimus Erythropoietin Antidepressants Nonsteroidal anti-inflammatory drugs Associated conditions Smoking Increasing obesity Sleep apnea Insulin resistance or hyperinsulinemia Ethanol intake of more than 1 oz (30 mL) per day Anxiety-induced hyperventilation or panic attacks Chronic pain Intense vasoconstriction (arteritis) Organic brain syndrome (e.g., memory deficit) Identifiable causes of hypertension Adapted from JNC-7 Express, National Heart, Lung, and Blood Institute

Aggregation happens when individual peptide molecules begin clumping together in solution, often triggered by mechanical agitation, temperature fluctuation, or simply time this is the underlying reason vigorous shaking is discouraged in favor of gentle swirling
This results in: Greater muscular endurance Reduced fatigue and faster recovery between sets and sessions Steroids like Equipoise and Testosterone Cypionate are often praised for these performance-enhancing cardiovascular benefits
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