Document Detail


Evaluation and pharmacologic approach to patients with resistant hypertension.
MedLine Citation:
PMID:  22314117     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
Molly Adams; Jessica M Bellone; Bradley M Wright; Gregory W Rutecki
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Postgraduate medicine     Volume:  124     ISSN:  1941-9260     ISO Abbreviation:  Postgrad Med     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-02-08     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401147     Medline TA:  Postgrad Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  74-82     Citation Subset:  AIM; IM    
Affiliation:
Clinical Pharmacy Specialist, Internal Medicine, Department of Pharmacy, CJW Medical Center-Chippenham Campus, Richmond, VA. molly.adams@hcahealthcare.com.
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