Resistant or Difficult-to-Control Hypertension

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Abstract
A 70-year-old woman with a long-standing history of hypertension comes for follow-up. Her medications include atenolol (100 mg daily), hydrochlorothiazide (12.5 mg daily), lisinopril (40 mg daily), and ibuprofen (400 mg twice daily for osteoarthritis). She does not smoke or drink alcohol. Her body-mass index is 32. Her blood pressure (measured three times while she is seated) ranges from 164/92 to 170/96 mm Hg; her pulse rate is 72 per minute. Examination of her ocular fundi reveals arteriolar narrowing. The results of cardiovascular examination are normal. How should she be further evaluated and treated?