CCBs, inhibitors of RAS, and chlorthalidone comprise a common 3-drug regimen.S11.1-11 Considerable evidence indicates that the addition of spironolac- tone to multidrug regimens provides substantial BP reductionS11.1-12 when compared with placebo. Substantial data also demonstrate the advantage of spironolactone as compared with other active In particular, the recent PATHWAY-2 (Optimum Treatment for Drug-Resistant Hypertension) RCT demonstrated the superiority of spironolactone over alpha and beta There is also clinical trial evidence that the addition of hydralazine or minoxidil is effective in achieving BP control in patients resistant to usual combination therapy.S11.1-8,S11.1-12 S11.1-16 The dosing of multidrug regimens, occasionally including night- time dosing, may be best optimized by hypertension specialists. Several studies have investigated devices that interrupt sympathetic nerve activity (carotid baroreceptor pacing and catheter ablation of renal sympathetic nerves); how- ever, these studies have not provided sufficient evidence to Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e65 recommend the use of these device in managing resistant In particular, 2 RCTS of renal sympa- thetic nerve ablation have been negative.S11.1-8,S11.1-9 11.2. Hypertensive Crises Emergencies and Urgencies Recommendations for Hypertensive Crises and Emergencies References that support recommendations are summarized in Online Data Supplement 55. COR LOE Recommendations I B-NR 1. In adults with a hypertensive emergency, admission to an intensive care unit is recommended for continuous monitoring of BP and target organ damage and for parenteral administration of an appropriate agent (Tables 19 and 20).S11.2-1,S11.2-2 I C-EO 2. For adults with a compelling condition (ie, aortic dissection, severe preeclampsia or eclampsia, or pheochromocytoma crisis), SBP should be reduced to less than 140 mm Hg during the first hour and to less than 120 mm Hg in aortic dissection. I C-EO 3. 