PATHWAY-2 Resistant Hypertension — ESENeph MCQ

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HardHypertensionPATHWAY-2 Resistant HypertensionESENeph

A man with CKD G3b has confirmed resistant hypertension despite ramipril, amlodipine and indapamide at tolerated doses. Adherence and secondary causes have been reviewed. Potassium is 4.7 mmol/L. What is the most appropriate next step under NICE guidance?

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Correct answer: B — Specialist review with an alpha- or beta-blocker

At step 4, NICE suggests low-dose spironolactone when potassium is 4.5 mmol/L or lower, with particular caution in reduced eGFR. When potassium is above 4.5 mmol/L, an alpha- or beta-blocker can be considered and specialist advice is appropriate. The original item omitted potassium and proposed adding spironolactone after doxazosin as though the sequence were universal. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: NICE NG136: Hypertension in adults. https://www.nice.org.uk/guidance/ng136/chapter/recommendations