Prevention and Treatment
- Hypertensive patients with left ventricular hypertrophy should be treated with antihypertensive therapy to decrease the rate of subsequent cardiovascular events (Grade C).
- The choice of initial therapy can be influenced by the presence of left ventricular hypertrophy (Grade D). Initial therapy can be drug treatment using ACE inhibitors, ARBs, long-acting CCBs, or thiazide/thiazide-like di-uretics. Direct arterial vasodilators such as hydralazine or minoxidil should not be used.
- Resistant hypertension is defined as BP above target despite 3 or more BP-lowering drugs at optimal doses preferably including a diuretic (and usually a renin-angiotensin-aldosterone system blocker and a CCB).
- Accurate office and out-of-office BP measurement is essential.
- Other reasons for apparent resistant hypertension should be eliminated before diagnosing true resistant hypertension, including nonadherence, white coat effect, and secondary hypertension.
- Pharmacotherapy with the additional use of spi-ronolactone, bisoprolol, doxazosin, amiloride, eplerenone, or clonidine with the baseline regimen decreases BP significantly, with the greatest BP-lowering shown with spironolactone.