Chart 16.2. – Treatment of resistant hypertension.

Intervention	LR	LE
Prescribe and encourage LSCs	I	B
Optimize treatment with three medications: hydrochlorothiazide, chlorthalidone or indapamid,* ACEI or ARB, and CCB†	I	B
Add spironolactone as the 4 th medication	I	A
Add a BB and/or clonidine as the 5 th /6 th medication†	IIA	B
Add direct-acting vasodilators sequentially	IIB	C
Prescribe the nocturnal administration of one or more drugs at bedtime	IIB	B
Check and improve adherence to treatment	I	C
Do not use invasive treatment, except in research protocols	III	B
* With glomerular filtration rate ≤ 30 mL/min or CHF, use loop diuretic.