Open AccessOrgan damage changes in patients with resistant hypertension randomized to renal denervation or spironolactone: The DENERVHTA (Denervación en Hipertensión Arterial) study
Author(s) -
Oliveras Anna,
Armario Pedro,
Sans Laia,
Clarà Albert,
Vázquez Susana,
Molina Luis,
Pareja Júlia,
Sierra Alejandro,
Pascual Julio
Publication year - 2018
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.13156
Subject(s) - medicine , spironolactone , blood pressure , denervation , albuminuria , diuretic , urology , excretion , cardiology , endocrinology , heart failure
Renal denervation and spironolactone have both been proposed for the treatment of resistant hypertension, but their effects on preclinical target organ damage have not been compared. Twenty‐four patients with 24‐hour systolic blood pressure ≥140 mm Hg despite receiving three or more full‐dose antihypertensive drugs, one a diuretic, were randomized to receive spironolactone or renal denervation. Changes in 24‐hour blood pressure, urine albumin excretion, arterial stiffness, carotid intima‐media thickness, and left ventricular mass index were evaluated at 6 months. Mean baseline‐adjusted difference between the two groups (spironolactone vs renal denervation) at 6 months in 24‐hour systolic blood pressure was −17.9 mm Hg (95% confidence interval [ CI ], −30.9 to −4.9; P = .01). Mean baseline‐adjusted change in urine albumin excretion was −87.2 (95% CI , −164.5 to −9.9) and −23.8 (95% CI , −104.5 to 56.9), respectively ( P = .028). Mean baseline‐adjusted variation of 24‐hour pulse pressure was −13.5 (95% CI , −18.8 to −8.2) and −2.1 (95% CI , −7.9 to 3.7), respectively ( P = .006). The correlation of change in 24‐hour systolic blood pressure with change in log‐transformed urine albumin excretion was r = .713 ( P < .001). At 6 months there was a reduction in albuminuria in patients with resistant hypertension treated with spironolactone as compared with renal denervation.