Elderly Man has hypertension already on ACEI &CCB BUT STILL NOT Controlled Bp 158/90WHAT TO ADD?

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Core Concept: Management of resistant or uncontrolled hypertension using combination therapy.

Clinical Presentation:

• Persistently elevated blood pressure (158/90 mmHg) despite dual therapy with an ACE inhibitor and a Calcium Channel Blocker.
• Complications: Stroke, myocardial infarction, heart failure, chronic kidney disease.

Diagnosis:

• First-line: Accurate BP measurement, basic metabolic panel (to check potassium and creatinine before adding a diuretic).

Management:

• Acute/Long-term: Guidelines (e.g., ACC/AHA, ESC) recommend a 3-drug regimen for uncontrolled BP on two agents. The optimal combination includes an ACEi/ARB, a CCB, and a Thiazide-like diuretic (e.g., chlorthalidone or indapamide). Beta-blockers are not first-line add-on agents unless there is a specific compelling indication (e.g., heart failure, post-MI, angina).