Management of resistant arterial hypertension: role of spironolactone versus double blockade of the renin-angiotensin-aldosterone system

Journal of Hypertension
Beatriz Alvarez-AlvarezNieves Martell-Claros

Abstract

Currently there is no consensus regarding which add-on therapy to use in resistant hypertension. This study was designed to compare two treatment options, spironolactone (SPR) versus dual blockade of the renin-angiotensin-aldosterone system (RAAS). Forty-two patients with true resistant hypertension were included in the study. An open-label prospective crossover design was used to add a second RAAS blocker to previous treatment and then SPR following 1 month of wash-out. BP was measured in the office and by ambulatory blood pressure monitoring (ABPM). Changes in laboratory tests were also studied for both treatments. The predictive values of aldosterone-renin ratio (ARR) and serum potassium of determining the antihypertensive response were analyzed for both arms. Following the first stage of dual blockade, SBP dropped significantly both in office (reduction of 12.9 ± 19.2 mmHg)) and by ABPM (reduction of 7.1 ± 13.4 mmHg). Office DBP was unchanged but was significantly reduced as measured by ABPM (3.4 ± 6.2 mmHg). On SPR treatment, office BP was reduced 32.2 ± 20.6/10.9 ± 11.6 mmHg. By ABPM the reduction was 20.8 ± 14.6/8.8 ± 7.3 mmHg (P < 0.001). The BP control was achieved by 25.6% of patients in dual blockade and 53.8% in SPR...Continue Reading

References

Dec 1, 1981·The Journal of Endocrinology·J StaessenA Amery
Jan 21, 1993·The American Journal of Cardiology·D C SchohnB C Pelletier
May 24, 2000·Journal of Human Hypertension·P O LimT M MacDonald
Feb 24, 2001·American Journal of Hypertension·J Laragh
Mar 29, 2001·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·B J GallayR C Davidson
May 7, 2002·American Journal of Hypertension·James OuzanMichel Mertes
Oct 24, 2003·American Journal of Hypertension·Mari Konishi NishizakaDavid A Calhoun
Jan 14, 2004·Hypertension·Theodore L GoodfriendKasem Nithipatikom
Feb 20, 2004·Journal of Human Hypertension·B WilliamsUNKNOWN British Hypertension Society
Oct 14, 2004·Journal of Hypertension·Ivar K EideNils P Lilledahl
May 26, 2005·Current Hypertension Reports·Monique N Pratt-UbunamaDavid A Calhoun
Apr 4, 2006·American Journal of Hypertension·Michelangelo SartoriAndrea Semplicini
Apr 8, 2006·Current Hypertension Reports·Valéria Lamounier-Zepter, Monika Ehrhart-Bornstein
Jun 27, 2006·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Martin MacKinnonHeather D Clark
Jul 4, 2006·American Journal of Hypertension·Yehonatan SharabiEhud Grossman
Jul 28, 2006·The New England Journal of Medicine·Marvin Moser, John F Setaro
Feb 21, 2007·Hypertension·Neil ChapmanUNKNOWN Anglo-Scandinavian Cardiac Outcomes Trial Investigators
Mar 14, 2007·Journal of Hypertension·Deirdre A LaneD Gareth Beevers
Apr 2, 2008·The New England Journal of Medicine·UNKNOWN ONTARGET InvestigatorsCraig Anderson
Aug 23, 2008·Nutrition, Metabolism, and Cardiovascular Diseases : NMCD·C Dall'AstaA E Pontiroli
Feb 7, 2009·Journal of the American College of Cardiology·Franz H Messerli

❮ Previous
Next ❯

Citations

Sep 17, 2011·Current Hypertension Reports·Gary E Sander, Thomas D Giles
Apr 13, 2013·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Srividya Kidambi, Theodore A Kotchen
Aug 30, 2013·Journal of Human Hypertension·A Oliveras, A de la Sierra
Oct 16, 2010·Journal of Hypertension·Eduardo Pimenta, David A Calhoun
Dec 20, 2012·Journal of Hypertension·Pieter M JansenAnton H van den Meiracker
Jul 10, 2013·Vascular Health and Risk Management·Jason L GuichardMustafa I Ahmed
Oct 2, 2012·World Journal of Cardiology·Luis PaivaAntonio Leitao-Marques
Nov 7, 2012·Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia·Jan VaclavikMilos Taborsky
Dec 14, 2012·Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia·Jan VaclavikMilos Taborsky
Feb 14, 2014·Current Hypertension Reports·Piotr Czarniak, Aleksandra Zurowska
Oct 25, 2012·Annual Review of Medicine·David A Calhoun
Feb 19, 2011·International Journal of Hypertension·Maria Czarina Acelajado, David A Calhoun
Nov 25, 2014·Seminars in Nephrology·Michel Burnier, Gregoire Wuerzner
Sep 19, 2014·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Gian Paolo Rossi, Giuseppe Maiolino
Dec 3, 2014·Cardiology Clinics·Hossein GhofraniMitra K Nadim
Jul 6, 2013·Revista clínica española·P ArmarioA de la Sierra
Apr 24, 2012·The Canadian Journal of Cardiology·Donald ClarkDavid A Calhoun
Oct 4, 2011·Journal of the American Society of Hypertension : JASH·Julian SeguraLuis M Ruilope
Jun 1, 2013·Pharmacotherapy·Steven M Smith
Mar 10, 2015·Medicina clínica·Enrique GalveUNKNOWN Grupo de consenso español sobre denervación renal
Sep 10, 2016·American Journal of Hypertension·Tanja Dudenbostel, David A Calhoun
Oct 28, 2016·Current Hypertension Reports·Ján RosaJiří Widimský
Mar 31, 2018·Expert Opinion on Pharmacotherapy·Revathy CarnagarinMarkus P Schlaich
Mar 29, 2019·Circulation Research·Maria Czarina AcelajadoDavid A Calhoun
Feb 9, 2012·Postgraduate Medicine·Molly AdamsGregory W Rutecki
Feb 9, 2012·Postgraduate Medicine·Donald ClarkMustafa I Ahmed
Jan 4, 2020·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Emilio Antonio FrancischettiEvandro Silva Freire Coutinho
May 17, 2013·International Heart Journal·Yuji YoshitomiSatoru Suwa

❮ Previous
Next ❯

Related Concepts

Related Feeds

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 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.