Patients who have uncontrolled blood pressure (BP) despite being on maximally tolerated doses of 3 antihypertensive medications of different classes (one of which must be a diuretic) or who are controlled on 4 or more antihypertensive medications are defined as having resistant hypertension (RH). [1–3] An estimated 10–14% of hypertensive patients have treatment-resistant hypertension with the burden of RH being highest for patients with chronic kidney disease (CKD). [4] The most common fourth-line treatment is the addition of a mineralocorticoid receptor antagonist (MRA) to the treatment regimen.
