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Resistant Hypertension — EECC MCQ

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HardHypertension & Preventive CardiologyResistant HypertensionEECC

A 48-year-old man has resistant hypertension (BP 155/95 mmHg despite maximally tolerated triple therapy: amlodipine 10 mg, ramipril 10 mg, indapamide 2.5 mg). Adherence is confirmed. Secondary causes excluded. Serum potassium is 4.0 mmol/L. What is the recommended fourth-line agent?

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Correct answer: C — Spironolactone 25-50 mg

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · E = shown as D · A = shown as E

Per the 2024 ESC Hypertension Guidelines, spironolactone (25-50 mg) is the preferred fourth-line agent for resistant hypertension (Class I), based on the PATHWAY-2 trial. Beta-blockers (C) and alpha-blockers (A) are subsequent options. Clonidine (D) and hydralazine (E) are later-line agents with more side effects.

Reference: ESC (2024): Guidelines for the Management of Elevated Blood Pressure and Hypertension