Treating resistant hypertension

Question 1

Def of resistant HPT:

Answer 1

Require > 3 medications to control BP

Question 2

Rx approach:

Answer 2

1. Optimise diuretic
2. Optimise ACE-I w/ CCB
3. Add mineralocorticoid antagonist

Question 3

How to optimise diuretic?

Answer 3

1. Switch HCTZ to Chlorthalidone - x2 more potent
2. eGFR < 30 (renal impairment) - switch to loop diuretic

Question 4

Cautions with spironolcatone:

Answer 4

1. Risk of HyperK when used with - ACE-I or NSAIDs or CKD patients
2. CI if eGFR < 30