An algorithm for the management of resistant hypertension

Before hypertension can be considered resistant to a rational triple drug regimen in maximal doses, the physician should rule out poor adherence to the regimen (including diet), adverse drug interactions, pseudotolerance (due to fluid retention), office hypertension, pseudohypertension, and an unrecognized secondary cause (e.g., renovascular disease, primary aldosteronism, and pheochromocytoma). When these have been excluded, hemodynamic measurements are indicated to identify the mechanism(s) at fault so that the therapeutic regimen can be modified appropriately.