In Resistant Hypertension, Is Spironolactone or Clonidine a Better Choice for a Fourth Drug?

Resistant hypertension is an infrequent but difficult-to-manage clinical problem. After prescription of the common frontline drugs (diuretic, angiotensin-converting–enzyme inhibitor or angiotensin-receptor blocker, and calcium-channel blocker), the most suitable drug to add is uncertain. In the ReHOT study (Resistant Hypertension Optimal Treatment), researchers in Brazil compared spironolactone and clonidine as a fourth drug in patients with resistant hypertension.

In the two-phase study, 1597 hypertensive patients were treated with ≤3 drugs for 12 weeks, and 187 patients (11.7%) were identified as having resistant hypertension. Compared with the other patients, those with true resistant hypertension had higher incidences of stroke and diabe…