In those patients who remain above the BP goal despite a suitably titrated regimen including a -blocker and, if appro- priate, an ACE inhibitor, then a calcium channel blocker or a diuretic can be considered as a next therapy choice.A long-act- ing dihydropyridine calcium channel blocker can effectively reduce BP and prevent graft spasm (radial artery conduit) and may offer an antianginal effect. Nondihydropyridine calcium channel blockers such as verapamil and diltiazem are effec- tive antihypertensive agents, but they are generally reserved for rate control in patients with coexisting chronic obstructive pulmonary disease and normal LV function. Diuretic therapy can be used in the CABG patient with hypertension either for volume removal if the patient is edematous or for further BP reduction when given together with an ACE inhibitor or a Selection of a diuretic class depends on the level of renal function, with thiazide-type drugs generally reserved for patients with a glomerular filtration rate >30 mL/min and loop diuretics used for patients with lower glomerular filtra- tion rates and the need for a diuretic of greater potency.234 Resistant hypertension is no more common in the post- CABG patient than in the general hypertensive population, and the approach to treatment is fairly similar. In patients already treated with an ACE inhibitor, -blocker, diuretic, and calcium channel blocker who remain above goal BP, other treatment options include compounds that reduce adrenergic activity such as clonidine or doxazosin. In addition, a min- eralocorticoid receptor antagonist such as spironolactone or eplerenone can be effective in lowering BP in the patient with resistant hypertension, particularly in the setting of LV dys- function, while affording cardiovascular benefits, including reduced myocardial fibrosis, prevention or reversal of cardiac remodeling, or a reduction in arrhythmogenesis.235 Hypertension Management Recommendations 1. 