Resistant Hypertension — RACP Adult Medicine MCQ
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Correct answer: A — Add low-dose spironolactone with early potassium and kidney-function monitoring
Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E
A is correct. After confirmation of adherence, measurement technique and true resistance, a mineralocorticoid-receptor antagonist is the preferred fourth-line treatment when kidney function and potassium permit; suppressed renin and a raised ratio make aldosterone excess particularly plausible. B and C may lower BP but are generally less effective fourth-line choices for this phenotype. D duplicates the same nephron target and increases electrolyte toxicity. E exposes the patient to hyperkalaemia and kidney injury without routine outcome benefit. Spironolactone must not substitute for completing subtype evaluation when primary aldosteronism could be surgically curable, and potassium and creatinine should be checked soon after initiation and titration.
Reference: Heart Foundation: Guideline for the diagnosis and management of hypertension in adults: https://www.heartfoundation.org.au/getmedia/c83511ab-835a-4fcf-96f5-88d770582ddc/PRO-167_Hypertension-guideline-2016_WEB.pdf Endocrine Society: Primary aldosteronism clinical practice guideline: https://www.endocrine.org/clinical-practice-guidelines/primary-aldosteronism Australian RACP: Divisional Written Examination: https://www.racp.edu.au/trainees/examinations/divisional-written-examination