Treatment of hypertension in association with left ventricular hypertrophy

Recommendations

Hypertensive patients with left ventricular hypertrophy should be treated with antihypertensive therapy to decrease the rate of subsequent cardiovascular events (Grade C).
The choice of initial therapy can be influenced by the presence of left ventricular hypertrophy (Grade D). Initial therapy can be drug treatment using ACE inhibitors, ARBs, long-acting CCBs, or thiazide/thiazide-like di-uretics. Direct arterial vasodilators such as hydralazine or minoxidil should not be used.

Resistant hypertension is defined as BP above target despite 3 or more BP-lowering drugs at optimal doses preferably including a diuretic (and usually a renin-angiotensin-aldosterone system blocker and a CCB).
Accurate office and out-of-office BP measurement is essential.
Other reasons for apparent resistant hypertension should be eliminated before diagnosing true resistant hypertension, including nonadherence, white coat effect, and secondary hypertension.
Pharmacotherapy with the additional use of spi-ronolactone, bisoprolol, doxazosin, amiloride, eplerenone, or clonidine with the baseline regimen decreases BP significantly, with the greatest BP-lowering shown with spironolactone.