International Circulation: Resistant hypertension is still a great challenge for cardiologists. What is the current optimal strategy to treat these patients?
《国际循环》：顽固性高血压对心脏病专家来说仍然是一个很大的挑战。治疗这类病人当前最佳的策略是什么？

Williams Louis:  I will start responding first by saying that， with the available drugs we have， you probably shouldn’t see resistant hypertension in your normal practice.  You may see it occasionally in a specialists practice but with a judicious choice of drugs a physician should be able to control almost everyone’s blood pressure.  Where people run into problems is when the first persist with mono-therapy， at first continuing to increase the dose of one drug.  As you do that you rarely get additional reductions in blood pressure but do get a lot more side effects.  You might say that the patient is on the maximum dose of a drug and not respond and then call that resistant hypertension.  The problem is that this is not good therapy. Although some patients respond to standard doses of mono-therapy， it is becoming clear that if they don’t respond then you should quickly move to a mixed dose combination therapy.  Some would argue that， given the target pressures we have now， you may be better off starting with a fixed dose combination therapy.  In the occasion patient where the pressure tends to be a bit lower than you would like， then reduce the dose.  There are the two options.  Let’s say you start with and ACE and a diuretic， if you double the dose of the combination and you still don’t have adequate control then it makes sense to add in a small dose of