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Resistant Hypertension CKD — ESENeph MCQ

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ModerateHypertensionResistant Hypertension CKDESENeph

A 70-year-old man with CKD G4 is on Amlodipine 10 mg, Doxazosin 4 mg, and Ramipril 10 mg. His BP is 145/88 mmHg. He is not on a diuretic. According to NICE NG136, what medication should be added for resistant hypertension in CKD?

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Correct answer: C — Chlorthalidone or Indapamide (thiazide-like diuretic if eGFR allows) or loop diuretic

NICE NG136 (Hypertension, 2019) step 4 for resistant hypertension recommends adding either a low-dose Spironolactone (if K+ ≤4.5), or a thiazide-like diuretic, alpha-blocker, or beta-blocker. In CKD G4 (eGFR 15-29), thiazide-like diuretics become less effective and loop diuretics may be more appropriate for both BP and volume control. This patient is already on an alpha-blocker (Doxazosin), so adding a diuretic is the next logical step. Spironolactone is less suitable given CKD G4 and hyperkalaemia risk.

Reference: NICE NG136 2019 – Hypertension