Adding a Beta-Blocker or Aldosterone Antagonist to a Blood Pressure Regimen

Fourth-Line Medication Options

• For patients with resistant hypertension, an aldosterone antagonist like spironolactone provides a complementary mechanism of action to existing therapy, according to the International Society of Hypertension 1

Guidelines for Multi-Drug Therapy

• Multiple guidelines recommend a step-wise approach to hypertension management, adding agents from different classes when blood pressure remains uncontrolled, with the combination of CCB + thiazide diuretic + ACEI/ARB as the preferred approach for three-drug combinations 2, 3
• The International Society of Hypertension recommends adding an aldosterone antagonist like spironolactone when hypertension remains uncontrolled despite maximum doses of an ARB and CCB plus a diuretic 1

Rationale for Spironolactone as Fourth-Line Therapy

• Adding spironolactone addresses potential aldosterone escape that can occur with long-term ARB therapy, providing a complementary mechanism of action by blocking aldosterone receptors 1