Algorithm for Diagnosis and Management of Resistant Hypertension in CKD

Pseudoresistant Hypertension - Reduce barriers to adherence:

 • Prescribe generics

 • Use once-daily medications

 • Combination formulations

 • Patient education

 • Assess for adverse effects

Initiate Lifestyle Modifications

 • Low sodium diet mg/d)

 • Address obesity

 • Increase physical activity

 • DASH diet and reduce alcohol intake

 • Evaluate for and treat OSA

 • Discontinue BP-raising medications

Resistant Hypertension

1. Evaluate for CKD

2. Screen for primary aldosteronism

3. Consider other causes of 2° HTN

eGFR < 30 mL/min/1.73 m2: 

1. Add loop diuretic to existing thiazide

2. Titrate to "dry weight"

3. Hold if under dry weight

→Add mineralocorticoid antagonist

→Refer to HTN specialist



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