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.
If your blood pressure is stubbornly high and you’re not taking chlorthalidone or spironolactone, or if you are taking the ACE-ARB combination, ask your doctor why. There may be good reasons, but you should know what they are. Keep in mind that people who have both kidney disease and high blood pressure should take a loop diuretic like furosemide (Lasix), which is easier on the kidneys.