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Resistant hypertension is defined as failure to achieve a blood pressure of 150/90 mm Hg despite the use of a rational triple-drug regimen in optimal doses . However, any definition of resistant hypertension is arbitrary; data from the Framingham Heart Study showed that risk for cardiovascular morbidity and mortality is a function of the degree of hypertension without any clear “threshold” level. We do not believe that pretreatment levels of blood pressure alter this definition, although severe hypertension at the outset is more likely to be resistant than mild hypertension. The prevalence of resistant hypertension is 1% to 13%, depending on criteria used to define the phenomenon and characteristics of the study population.

Triple-drug regimen to be tried before diagnosing resistant hypertension*

. Oral diuretic
Equivalent to 25 mg of hydrochlorothiazide (Esidrix, HydroDIURIL, Oretic) or chlorthalidone (Hygroton) or

Equivalent to furosemide (Lasix), 320 mg/day, or metolazone (Zaroxolyn), 10 mg/day (if serum creatinine > 2.5 mg/dL)


2. Sympathetic inhibitor
Beta blocker (equivalent to propranolol [Inderal], 320 mg/day, or atenolol [Tenormin], 100 mg/day) or

Clonidine HCl (Catapres), 0.6 mg/day, or

Prazosin (Minipress), 20 mg/day, or

Methyldopa (Aldomet), 2 g/day


Other agent
Angiotensin-converting enzyme inhibitor (equivalent to captopril [Capoten], 200 mg/day, or benazepril HCl [Lotensin], 40 mg/day) or

Angiotensin II blocker (losartan potassium [Cozaar], 100 mg/day) or

Calcium channel blocker (equivalent to verapamil [Calan, Isoptin, Verelan], 480 mg/day, or nifedipine [Adalat, Procardia], 120 mg/day, or diltiazem HCl [Cardizem, Dilacor], 360 mg/day)


3. Direct vasodilator
Hydralazine HCl (Apresoline), 100 mg/day, or minoxidil (Loniten), 20 mg/day.

In Fact, we need to investigate in details the reason for the resistant hypertension. Detailed history and physical examination is done followed by investigations.

For further details, please contact

Dr. Ashok Kapoor Cardiologist



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