Document Detail

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    
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.
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    
Hospital Clínico San Carlos, Madrid, Spain.
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MeSH Terms
Aldosterone Antagonists / pharmacology
Antihypertensive Agents / pharmacology
Blood Pressure
Cross-Over Studies
Hypertension / drug therapy*
Middle Aged
Potassium / blood
Prospective Studies
Renin-Angiotensin System / drug effects*
Spironolactone / pharmacology*
Treatment Outcome
Reg. No./Substance:
0/Aldosterone Antagonists; 0/Antihypertensive Agents; 52-01-7/Spironolactone; 7440-09-7/Potassium
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

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