Hipertensión arterial resistente

A 53 year old woman with hypercholesterolemia treated with statins, with no history of cardiovascular disease, was referred to the Hypertension and Vascular Risk Unit for management of hypertension resistant to 4 antihypertensive agents at full doses. The patient had obesity, with a body mass index of 36.3 kg/m2 and office blood pressure 162/102 mm Hg. Physical examination showed no data of interest. Analysis: glucose 120 mg/dl, glycated Hb: 6.4%, albuminuria 68 mg/g, kidney function and study of the renin angiotensin system and other biochemical parameters were normal. Echocardiography: left ventricular mass, 131 g/m2 (normal, < 110 g/m2). True resistant hypertension was confirmed by ambulatory monitoring of blood pressure during 24 h (153/89 mm Hg). Spironolactone treatment (25 mg/day) was added and was well tolerated, with no change in renal function and kaliemia within normal (4.1 mmol/l) following the treatment. After 8 weeks, blood pressure was well controlled: office blood pressure 132/86 mm Hg and 24 h-ambulatory blood pressure: 128/79 mm Hg.