Use one of the following AI chatbots to explore current best practices in resistant hypertension management based on the prompt:
You have to paste it in, of course. Use judgement since AI can make errors
Copy this text below if the button doesn't work:
Your patient is a 58-year-old woman with a history of hypertension for 12 years. She's currently taking lisinopril 40mg daily, amlodipine 10mg daily, and hydrochlorothiazide 25mg daily. Despite these medications at maximum doses, her office BP readings consistently show 156/92 mmHg. She reports taking her medications regularly and following a low-sodium diet. She has a BMI of 32, is sedentary, and occasionally uses ibuprofen for knee pain. Her basic labs show normal renal function with a potassium of 3.8 mEq/L.
You suspect she has resistant hypertension. Based on current best practices:
1. How would you confirm this is truly resistant hypertension?
2. What medication adjustment would you recommend as the next step?
3. Which evaluation for secondary causes would be most appropriate?
4. What lifestyle modifications would you emphasize?
5. At what point would you consider referring her to a hypertension specialist?
*Hint: You might consider using the SMASHMOUTH approach - an acronym that stands for Sodium intake, Medications raising BP, Adherence issues, Sleep apnea, Home BP monitoring, Medications (appropriate regimen), Obstructive sleep apnea, Underdosed medications, Target organ damage, and Hyperaldosteronism. This is a systematic framework for evaluating and managing patients with resistant hypertension.*
Please include practical recommendations that can be implemented in a primary care setting, and explain your diagnostic and treatment rationale.