A 56-year-old Black man comes in with blood pressure (BP) 162/96 mm Hg, heart rate 78 bpm, estimated glomerular filtration rate 49 mL/min, potassium 4.2 mEq/L, and albuminuria 165 mg/g with no history of diabetes mellitus or cardiovascular disease on amlodipine 10 mg, hydrochlorothiazide (HCTZ) 12.5 mg, and olmesartan 40 mg.
The correct answer is: D. Adding spironolactone and changing HCTZ to chlorthalidone.
Answer choice D is the correct choice because the guidelines recommend spironolactone as the fourth drug to treat resistant hypertension and most BP guidelines recommend chlorthalidone or thiazide-like diuretics over HCTZ for better BP control.
Educational grant support provided by: Medtronic
To visit the course page for the Overcoming Challenges in Hypertension Management Grant, click here!
References
- Carey RM, Calhoun DA, Bakris GL, et al.; American Heart Association Professional/Public Education and Publications Committee of the Council on Hypertension, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, Council on Genomic and Precision Medicine, Council on Peripheral Vascular Disease, Council on Quality of Care and Outcomes Research, Stroke Council. Resistant hypertension: detection, evaluation, and management: a scientific statement from the American Heart Association. Hypertension 2018;72:e53-e90.
- Burnier M, Bakris G, Williams B. Redefining diuretics use in hypertension: why select a thiazide-like diuretic? J Hypertens 2019;37:1574-86.
- Khosla N, Chua DY, Elliott WJ, Bakris GL. Are chlorthalidone and hydrochlorothiazide equivalent blood-pressure-lowering medications? J Clin Hypertens (Greenwich) 2005;7:354-6.
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