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Management of resistant hypertension: Aldosterone antagonists or intensification of diuretic therapy?
Author(s) -
Verdalles Ursula,
García de Vinuesa Soledad,
Goicoechea Marian,
Macías Nicolas,
Santos Alba,
Perez de Jose Ana,
Verde Eduardo,
Yuste Claudia,
Luño Jose
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12475
Subject(s) - spironolactone , medicine , furosemide , diuretic , aldosterone , blood pressure , ambulatory blood pressure , renal function , urology , creatinine , loop diuretic , endocrinology , ambulatory , population , essential hypertension , environmental health
Abstrat Objective No consensus has been established as to which is the best fourth‐line agent in patients with resistant hypertension ( RHT ). The aim of the present study was to assess the effect of intensifying diuretic treatment with loop diuretic (furosemide) or aldosterone antagonist (spironolactone) on blood pressure ( BP) control in RHT . Methods The study population comprised 30 patients with RHT who were divided into two treatment arms. Fifteen patients received furosemide 40 mg/day and 15 patients received spironolactone 25 mg/day. Ambulatory BP monitoring was performed baseline, 3 and 6 months. Results Baseline BP was 162 ± 8/90 ± 6 mmHg, 70% men, mean age 63.3 ± 9.1 years 56.1% diabetic and estimated glomerular filtration rate (e GFR) 55.8 ± 16.5 mL/min per 1.73 m 2 . There were no significant differences between groups at baseline in age, gender, percentage diabetics, eGFR , BP , number of antihypertensive drugs, or aldosterone levels. At 6 months, systolic BP decreased by 24 ± 9.2 mmHg (from 163.6 ± 8.6 to 139.6 ± 8.1 mmHg) in the spironolactone group, compared with 13.8 ± 2.8 mmHg (from 162 ± 7.9 to 148 ± 6.4 mmHg) in the furosemide group ( P < 0.01). Diastolic BP fell 11 ± 8.1 mmHg in the spironolactone group compared with 5.2 ± 2.2 mmHg in the furosemide group ( P < 0.01). Significant reduction in urinary albumin creatinine ratio (from 173 ± 268 to 14 ± 24 mg/g, P < 0.01) was observed in the spironolactone group at 6 months. Multiple regression analysis showed that only treatment with spironolactone was associated with control of BP < 140/90 mmHg at 6 months. No severe adverse events were recorded. Conclusion Spironolactone is more effective than furosemide for control of BP in RHT patients, with a positive added effect on albuminuria. Spironolactone is safe in patients with mild kidney impairment, although serum potassium should be closely monitored, especially in diabetics.