Consider mineralocorticoid receptor antagonists as add-on therapy in treatment-resistant hypertension

Treatment-resistant hypertension is associated with an increased risk of cardiovascular morbidity and mortality. Treatment recommendations include a combination of at least three antihypertensive drug classes, including a diuretic. Although there is limited evidence to support selection of add-on therapy, mineralocorticoid receptor antagonists (e.g. spironolactone and eplerenone) can effectively reduce blood pressure when added to standard combination therapy, and should be considered as fourth-line treatment options. © 2015, Springer International Publishing Switzerland.