Managing resistant hypertension: focus on mineralocorticoid-receptor antagonists

Vascular Health and Risk Management
Juan Carlos Yugar-ToledoHeitor Moreno

Abstract

Mineralocorticoid-receptor antagonists (MRAs) have proven to be effective in some types of hypertension, especially in resistant hypertension (RHTN). In this phenotype of hypertension, the renin-angiotensin-aldosterone pathway plays an important role, with MRAs being especially effective in reducing blood pressure. In this review, we show the relevance of aldosterone in RHTN, as well as some clinical characteristics of this condition and the main concepts involving its pathophysiology and cardiovascular damage. We analyzed the mechanisms of action and clinical effects of two current MRAs - spironolactone and eplerenone - both of which are useful in RHTN, with special attention to the former. RHTN represents a significant minority (10%-15%) of hypertension cases. However, primary-care physicians, cardiologists, nephrologists, neurologists, and geriatricians face this health problem on a daily basis. MRAs are likely one of the best pharmacological options in RHTN patients; however, they are still underused.

Citations

Sep 12, 2019·Current Hypertension Reports·Omar AzzamMarkus P Schlaich
Dec 14, 2018·Jornal brasileiro de nefrologia : ʹorgão oficial de Sociedades Brasileira e Latino-Americana de Nefrologia·Elizabeth Silaid MuxfeldtCibele Isaac Saad Rodrigues
Mar 4, 2019·Current Hypertension Reports·Antonis A ManolisAntonis S Manolis
Aug 31, 2020·Journal of the Renin-angiotensin-aldosterone System : JRAAS·Lida FeyzJoost Daemen
Jul 5, 2019·Pharmacology & Therapeutics·M Elizabeth MossIris Z Jaffe

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pharmacotherapies

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