Drug therapy of apparent treatment-resistant hypertension: focus on mineralocorticoid receptor antagonists

Drugs
Daniel Glicklich, William H Frishman

Abstract

Apparent treatment-resistant hypertension (aTRH) is defined as blood pressure (BP) >140/90 mmHg despite three different antihypertensive drugs including a diuretic. aTRH is associated with an increased risk of cardiovascular events, including stroke, chronic renal failure, myocardial infarction, congestive heart failure, aortic aneurysm, atrial fibrillation, and sudden death. Preliminary studies of renal nerve ablation as a therapy to control aTRH were encouraging. However, these results were not confirmed by the Symplicity 3 trial. Therefore, attention has refocused on drug therapy. Secondary forms of hypertension and associated conditions such as obesity, sleep apnea, and primary aldosteronism are common in patients with aTRH. The pivotal role of aldosterone in the pathogenesis of aTRH in many cases is well recognized. For patients with aTRH, the Joint National Committee-8, the European Society of Hypertension, and a recent consensus conference recommend that a diuretic, ACE inhibitor, or angiotensin receptor blocker and calcium channel blocker combination be used to maximally tolerated doses before starting a 'fourth-line' drug such as a mineralocorticoid receptor (MR) antagonist. Although the best fourth-line drug for aTRH ...Continue Reading

Associated Clinical Trials

References

Oct 14, 1982·The New England Journal of Medicine·UNKNOWN Hypertension Detection and Follow-up Program Cooperative Group
Apr 29, 1998·Mineral and Electrolyte Metabolism·B CianciarusoL De Nicola
May 20, 2000·Hypertension·K MasuoM L Tuck
May 7, 2002·American Journal of Hypertension·James OuzanMichel Mertes
May 23, 2002·Hypertension·Sandra J TalerJo Ellen Augustine
Dec 20, 2002·JAMA : the Journal of the American Medical Association·UNKNOWN ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatm
Feb 14, 2003·The New England Journal of Medicine·Lindon M H WingUNKNOWN Second Australian National Blood Pressure Study Group
Feb 25, 2003·Journal of the American College of Cardiology·Shu KasamaMasahiko Kurabayashi
May 16, 2003·JAMA : the Journal of the American Medical Association·Aram V ChobanianUNKNOWN National High Blood Pressure Education Program Coordinating Committee
Oct 24, 2003·American Journal of Hypertension·Mari Konishi NishizakaDavid A Calhoun
Nov 14, 2003·Proceedings of the National Academy of Sciences of the United States of America·M Ehrhart-BornsteinS R Bornstein
Dec 24, 2004·The New England Journal of Medicine·Lars SjöströmUNKNOWN Swedish Obese Subjects Study Scientific Group
Jul 4, 2006·American Journal of Hypertension·Yehonatan SharabiEhud Grossman
Feb 21, 2007·Hypertension·Neil ChapmanUNKNOWN Anglo-Scandinavian Cardiac Outcomes Trial Investigators
Mar 14, 2007·Journal of Hypertension·Deirdre A LaneD Gareth Beevers
Jan 8, 2008·Current Hypertension Reports·Eduardo Pimenta, David A Calhoun
Sep 4, 2008·Current Hypertension Reports·Theodore L Goodfriend
Nov 26, 2008·Archives of Internal Medicine·Gil F SallesElizabeth S Muxfeldt
Dec 5, 2008·The New England Journal of Medicine·Kenneth JamersonUNKNOWN ACCOMPLISH Trial Investigators
Jun 12, 2009·Journal of Hypertension·Pieter M JansenAnton H van den Meiracker
Nov 27, 2009·The New England Journal of Medicine·Michael E Ernst, Marvin Moser
Jan 15, 2010·JAMA : the Journal of the American Medical Association·Katherine M FlegalLester R Curtin
Aug 14, 2010·American Journal of Hypertension·Leonardo A SechiCristiana Catena
Oct 6, 2010·Hypertension·John M FlackUNKNOWN International Society on Hypertension in Blacks
Dec 3, 2010·The Journal of Clinical Hypertension·Michael E Ernst, Brian C Lund
Mar 26, 2011·American Journal of Therapeutics·Angela Brown, Becky Captain

❮ Previous
Next ❯

Citations

Jan 6, 2016·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Karl FenglerPhilipp Lurz
Apr 14, 2016·Current Hypertension Reports·Giorgina Barbara PiccoliTullia Todros
Jul 31, 2020·BMC Pharmacology & Toxicology·Yoshiaki KirigayaHitoshi Ishizuka
Jul 5, 2019·Pharmacology & Therapeutics·M Elizabeth MossIris Z Jaffe

❮ Previous
Next ❯

Related Concepts

Related Feeds

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.

Antimicrobial Resistance (ASM)

Antimicrobial resistance poses a significant threat to the continued successful use of antimicrobial agents for the treatment of bacterial infections.

Aortic Aneurysm

An aortic aneurysm is the weakening and bulging of the blood vessel wall in the aorta. This causes dilatation of the aorta, which is usually asymptomatic but carries the risk of rupture and hemorrhage. Find the latest research on aortic aneurysms here.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Cardiac Aneurysm

Aneurysm refers to a bulge of the wall or lining of a vessel commonly occurring in the blood vessels at the base of the septum or within the aorta. In the heart, it usually arises from a patch of weakened tissue in a ventricular wall, which swells into a bubble filled with blood. Discover the latest research on cardiac aneurysm here.

Antimicrobial Resistance

Antimicrobial resistance poses a significant threat to the continued successful use of antimicrobial agents for the treatment of bacterial infections.

Antihypertensive Agents: Mechanisms of Action

Antihypertensive drugs are used to treat hypertension (high blood pressure) which aims to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Discover the latest research on antihypertensive drugs and their mechanism of action here.

Cardiovascular Disease Pathophysiology

Cardiovascular disease involves several different processes that contribute to the pathological mechanism, including hyperglycemia, inflammation, atherosclerosis, hypertension and more. Vasculature stability plays a critical role in the development of the disease. Discover the latest research on cardiovascular disease pathophysiology here.

Cardiovascular Diseases: Risk Factors

Cardiovascular disease is a significant health concern. Risk factors include hypertension, obesity, dyslipidemia and smoking. Women who are postmenopausal are at an increased risk of heart disease. Here is the latest research for risk factors of cardiovascular disease.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.