title: A simplified mechanistic algorithm for treating resistant hypertension: efficacy in a retrospective study.
abstract: This retrospective study assessed the efficacy of a recently described, mechanism-based algorithm for treating resistant hypertension. Charts of consecutive patients seen for resistant hypertension were reviewed. Algorithm-based intervention was limited to either or both of just 2 options: (1) strengthening of the diuretic regimen, usually with addition of spironolactone; and (2) treatment with the combination of an α- + nonmetabolized β-blocker. Of 27 patients, 24 (89%) achieved control, including 13 (54%) in whom the diuretic regimen was strengthened, 6 (25%) in whom α-/β-blockade was instituted, and 5 (21%) who received both interventions. The most frequent medication adjustments were addition of a potassium-sparing diuretic in 16 (67%), doxazosin in 9 (37.5%), and replacing a metabolized with a nonmetabolized β-blocker in 6 (25%). The authors conclude that treatment based on this algorithm can both simplify and improve the management of resistant hypertension and merits further evaluation in prospective studies.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Weill/Cornell Medical Center, New York Presbyterian Hospital, New York, NY 10021, USA. sjmann@med.cornell.edu
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Mann
authors.forename: Neal S
authors.initials: NS
authors.lastname: Parikh
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D017211:Treatment Failure
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D004232:Diuretics