Evaluation and pharmacologic approach to patients with resistant hypertension.
Patients are diagnosed as having resistant hypertension when they have blood pressure readings that remain above goal despite the concomitant use of 3 optimally dosed antihypertensive agents from different classes, with 1 of the agents being a diuretic. Prior to diagnosing a patient as having resistant hypertension, it is important to document adherence and exclude white-coat hypertension, inaccurate measurement of blood pressure, and secondary causes of hypertension (eg, aldosterone excess). After determining resistance, optimization of the medication regimen is essential. Combination strategies, which might include dual renin-angiotensin-aldosterone blockade with spironolactone as 1 agent, have been proven successful. This article focuses on the safety and efficacy of spironolactone when added to an optimized 3-drug regimen. Additionally, the use of spironolactone in chronic kidney disease and obstructive sleep apnea complicated by resistant hypertension is discussed. These 2 clinical entities are frequently accompanied by resistant hypertension and are indications for the use of spironolactone as well.
Department of Pharmacy, CJW Medical Center-Chippenham Campus, Richmond, VA 23225, USA. molly.adams@hcahealthcare.com
Molly
M
Adams
Jessica M
JM
Bellone
Bradley M
BM
Wright
Gregory W
GW
Rutecki
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy; D012084:Renin-Angiotensin System / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000188:drug therapy; D013148:Spironolactone / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone