The addition of drugs to the patient’s therapeutic regimen
to achieve goal blood pressure other than those combinations
included in Figure 2 sometimes is necessary. In selected patients,
especially those with evidence of increased sympathetic
nervous system activity, _1-receptor antagonists and
sympatholytic agents including clonidine and reserpine may
be indicated. In the patient whose blood pressure still is
increased despite 3-drug therapy (defined as resistant hypertension
by JNC 71), the addition of low-dose spironolactone
should be considered. An additional mean blood pressure
reduction of 25/12 mm Hg was achieved in both African-
American and Caucasian resistant hypertensive patients taking
calcium antagonists, ACEIs, and diuretics 6 months after
adding spironolactone to this regimen in doses titrated up to
50 mg.90 The response to spironolactone was similar in those
patients with and without evidence of hyperaldosteronism