Drug Adherence

If the blood pressure goal has still not been obtained then I think it's important to reassess for drug adherence. That again will often dramatically reduce blood pressure and especially in those hypertensive people with suppressed plasma marine inactivity even though they don't have primary aldosteroneism. And then if the patient is still having problems there are accumulating data suggesting that renal denervation may be an option. But at the time our guideline was written in 2017 it was really experimental and still is butI think it's on the way to receiving approval for certain kinds of hypertension particularly resistant hypertension.