A Simplified Mechanistic Algorithm for Treating Resistant Hypertension: Efficacy in a Retrospective Study


Samuel J. Mann, MD, Division of Nephrology and Hypertension, Department of Medicine, Weill/Cornell Medical Center, New York Presbyterian Hospital, New York, NY 10021
E-mail: sjmann@med.cornell.edu


J Clin Hypertens (Greenwich). 2012;14:191–197. ©2012 Wiley Periodicals, Inc.

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.