Adult Patient with Pseudo-Resistant Hypertension: Drug Intolerance

  • Massimo Salvetti
Part of the Practical Case Studies in Hypertension Management book series (PCSHM)


Despite the increasing evidence of the severe consequences of uncontrolled blood pressure, in a large proportion of patients, BP targets are not achieved. Today, several classes of effective antihypertensive drugs are available, and in particular ACE inhibitors, angiotensin II receptor blockers, calcium antagonists, diuretics and beta blockers are all considered first-line drugs by current European Guidelines; furthermore, other molecules may be added as needed. However, in everyday practice clinicians may face with some problems related to drug treatment. In fact, in some patients, the number of drugs available for the treatment of hypertension is limited. This clinical case describes the eventuality in which patients are intolerant to more than one antihypertensive drug class. In patients with difficult-to-treat hypertension, this may represent a serious barrier to BP control. In the case described here, blood pressure control was obtained combining a renin angiotensin system blocker with a thiazide-like diuretic and a mineralocorticoid receptor antagonist. Antialdosterone drugs are not among the recommended first-line drugs for hypertension but, as also indicated by the ESH ESC Hypertension Guidelines, can be used as a third- or fourth-line drugs, being among the most effective additional antihypertensive drugs.


Calcium Antagonist Ambulatory Blood Pressure Monitoring Fixed Combination Mineralocorticoid Receptor Antagonist Blood Pressure Profile 
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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Massimo Salvetti
    • 1
  1. 1.ASST Spedali Civili di BresciaClinica Medica-University of BresciaBresciaItaly

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