| Management of resistant arterial hypertension: role of spironolactone versus double blockade of the renin-angiotensin-aldosterone system. | |
| | |
MedLine Citation:
|
PMID: 20651602 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: 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). METHODS: 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. RESULTS: 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 with office blood pressure. By ABPM, 20.5% were controlled on dual blockade and up to 56.4% with SPR. Serum potassium was a weak inverse predictor of the blood pressure-lowering effect of SPR. CONCLUSION: SPR has a greater antihypertensive effect than dual blockade of the RAAS in resistant hypertension. SPR at daily doses of 25-50 mg shows a potent antihypertensive effect when added to prior regimes of single RAAS axis blockade in patients with resistant arterial hypertension. |
| | |
Authors:
|
Beatriz Alvarez-Alvarez; María Abad-Cardiel; Arturo Fernandez-Cruz; Nieves Martell-Claros |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Journal of hypertension Volume: 28 ISSN: 1473-5598 ISO Abbreviation: J. Hypertens. Publication Date: 2010 Nov |
Date Detail:
|
Created Date: 2010-10-15 Completed Date: 2011-02-02 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8306882 Medline TA: J Hypertens Country: England |
Other Details:
|
Languages: eng Pagination: 2329-35 Citation Subset: IM |
Affiliation:
|
Hospital Clínico San Carlos, Madrid, Spain. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Aldosterone Antagonists / pharmacology Antihypertensive Agents / pharmacology Blood Pressure Cross-Over Studies Female Humans Hypertension / drug therapy* Male Middle Aged Potassium / blood Prospective Studies Renin-Angiotensin System / drug effects* Spironolactone / pharmacology* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
|
0/Aldosterone Antagonists; 0/Antihypertensive Agents; 52-01-7/Spironolactone; 7440-09-7/Potassium |
| Comments/Corrections | |
Comment In:
|
J Hypertens. 2010 Nov;28(11):2194-5
[PMID:
20948392
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: The utility of the Faces Pain Scale in the assessment of shoulder pain in Turkish stroke patients: i...
Next Document: Longitudinal trends in cardiovascular mortality and blood pressure levels, prevalence, awareness, tr...