Abstract-The role of spironolactone in resistant hypertension management is unclear. The aim of this prospective trial was to evaluate the antihypertensive effect of spironolactone in patients with true resistant hypertension diagnosed by ambulatory blood pressure monitoring. A total of 175 patients had clinical and complementary exams obtained at baseline and received spironolactone in doses of 25 to 100 mg/d. A second ambulatory blood pressure monitoring was performed after a median interval of 7 months. Paired Student t test was used to assess differences in blood pressure before and during spironolactone administration, and multivariate analysis adjusted for age, sex, and number of antihypertensive drugs to assess the predictors of blood pressure fall. There were mean reductions of 16 and 9 mm Hg, respectively, in 24-hour systolic and diastolic blood pressures (95% CIs: 13 to 18 and 7 to 10 mm Hg; PϽ0.001). Office systolic blood pressure and diastolic blood pressure also decreased (14 and 7 mm Hg). Controlled ambulatory blood pressure was reached in 48% of patients. Factors associated with better response were higher waist circumference, lower aortic pulse wave velocity, and lower serum potassium. No association with plasma aldosterone or aldosterone:renin ratio was found. Adverse effects were observed in 13 patients (7.4%). A third ambulatory blood pressure monitoring performed in 78 patients after a median of 15 months confirmed the persistence of the spironolactone effect. In conclusion, spironolactone administration to true resistant hypertensive patients is safe and effective in decreasing blood pressure, especially in those with abdominal obesity and lower arterial stiffness. Its addition to an antihypertensive regimen as the fourth or fifth drug is recommended. (Hypertension. 2010;55:147-152.)Key Words: ambulatory blood pressure monitoring Ⅲ resistant hypertension Ⅲ spironolactone R esistant hypertension (RH) is a common clinical condition defined as the failure to control office blood pressure (BP) despite a treatment with Ն3 different classes of antihypertensive drugs in optimal dosages, ideally including a diuretic. 1 Previous surveys have shown prevalence ranges from 10% to Ϸ30%. 1 Although there is no consensus about the better therapeutic scheme for resistant hypertensive patients, in general, diuretics, angiotensin-blocking agents, calciumchannel blockers, and ␤-blockers are used as the first-line choices. However, there is a lack of evidence about the optimal choice of a fourth-or fifth-line antihypertensive drug, and in this context there has been increasing interest in the role of aldosterone antagonists, particularly spironolactone.The efficacy and safety of spironolactone in reducing BP were demonstrated Ͼ2 decades ago. 2 Over the past 15 years, after many reports had suggested that primary hyperaldosteronism is probably more common than it was regarded previously, 3,4 several studies have been dedicated to evaluate the spironolactone effect in patients with refractoriness to treatment, mo...

Abstract-The effect of continuous positive airway pressure (CPAP) on blood pressures (BPs) in patients with resistant hypertension and obstructive sleep apnea is not established. We aimed to evaluate it in a randomized controlled clinical trial, with blinded assessment of outcomes. Four hundred thirty-four resistant hypertensive patients were screened and 117 patients with moderate/severe obstructive sleep apnea, defined by an apnea-hypopnea index ≥15 per hour, were randomized to 6-month CPAP treatment (57 patients) or no therapy (60 patients), while maintaining antihypertensive treatment. Clinic and 24-hour ambulatory BPs were obtained before and after 6-month treatment. Primary outcomes were changes in clinic and ambulatory BPs and in nocturnal BP fall patterns. Intention-to-treat and per-protocol (limited to those with uncontrolled ambulatory BPs) analyses were performed. Patients had mean (SD) 24-hour BP of 129 (16)

ClinicalTrials.gov Identifier: NCT01508754.