When to Refer

The European AIDS Clinical Society (EACS) recommend an incremental approach to pharmacotherapy for hypertension, starting with one anti-hypertensive agent and successively adding agents from different classes until three agents are tried in combination.1

  • Patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic, but fail to reach goal blood pressure (BP), are said to have resistant hypertension.2,3
  • Consultation with a specialist or a hypertension centre should be considered if BP goals are not achieved within 6 months or if control is subsequently lost.2,3
    • Requirement of 4–5 drugs to manage hypertension requires specialist training.1
    • Resistant hypertension may be associated with subclinical organ damage and added cardiovascular (CV) risk.2

Refer to the European Society of Hypertension and European Society of Cardiology (ESH/ESC) guidelines (2007) or the US Department of Health and Human Services (US DHHS) JNC7 express report (2003) for specific considerations in patients (not HIV-specific) with:

  • resistant hypertension
  • acute target-organ damage and hypertensive emergencies
  • malignant hypertension.


  1. European AIDS Clinical Society (EACS). Guidelines. Version 6.0. Accessed 3 July 2012.
  2. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the Management of Arterial Hypertension. Eur Heart J. 2007;28:1462–1536.
  3. US Department of Health and Human Services. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. December 2003. Accessed 8 March 2011.