Harvard Heart Letter

Which drugs work best for resistant high blood pressure?

If you have resistant high blood pressure (hypertension), you are probably already doing a lot to lower it. But a study suggests that people with resistant hypertension rarely get two particularly effective drugs, and often they get a drug combination that's not very helpful.

Resistant hypertension occurs when blood pressure stays high despite taking three or more drugs, or when a person needs four or more drugs to reach blood pressure goals. Colorado researchers reviewed insurance claims for more than 140,000 such people. Only 3% were receiving chlorthalidone (Hydone, generic), a diuretic (water pill) that several studies suggest is more effective at reducing blood pressure and curbing bad cardiovascular consequences than the most-often-prescribed diuretic, hydrochlorothiazide (HydroDiuril, generic).

Also, only 6% of the people were prescribed an aldosterone blocker such as spironolactone, which guidelines recommend for resistant hypertension. Meanwhile, more than 15% received an ACE inhibitor plus an angiotensin-receptor blocker (ARB), a combination that evidence indicates is not very effective (Hypertension, December 2011). In late 2011, the FDA approved the first chlorthalidone-ARB combination (Edarbyclor), which could make taking this effective combo more convenient.

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