Background:
Mineralocorticoid receptor antagonists are a second-line class of antihypertensive drugs,
which have been accounted for as the optimal add-on therapy in the triple algorithm for the management of resistant
hypertension.
Objectives:
To assess the effects of mineralocorticoid receptor antagonists in the treatment of patients with essential
hypertension and resistant hypertension.
Method:
We conducted a meticulous review of the literature and comprehensive identification of the clinical
trials assessing the efficacy of mineralocorticoid receptor antagonists in individuals with primary and resistant
hypertension.
Results:
MRAs have been thoroughly tested in several clinical studies in relevance to blood pressure lowering
effects, over the last six decades. Accumulating data observed that MRAs resulted in a significant reduction in
blood pressure level in patients with resistant hypertension. In addition, spironolactone was found to beneficially
affect the management of resistant hypertension.
Conclusion:
Mineralocorticoid receptor antagonists exert a significant antihypertensive effect. Future welldesigned
randomized controlled studies are greatly needed to address crucial clinical aspects in the field.
The initial data suggest clinically meaningful benefits of the SGLT-2 inhibitors in diabetic patients in relevance with chronic kidney disease. Future, well-designed randomised clinical trials need to be further investigated such as nephroprotective outcomes, that if confirmed, could lead to new perspectives in the management of diabetic nephropathy.
Background:
Hypertension of pregnancy [office blood pressure (BP) levels≥140/90 mmHg] is fairly common and can affect up to 10% of pregnant women worldwide. Hypertension of pregnancy is an important risk factor for the mother and carries increased morbidity and mortality for the fetus. Women with hypertension of pregnancy have a high-risk for future cardiovascular and renal events.
Objectives:
To summarize the literature related to several clinical aspects of hypertension in pregnancy and draw clinically meaningful conclusions.
Method:
We conducted an in-depth review of the literature to retrieve existing data on the definition, epidemiology, classification, and management of hypertension in pregnancy.
Results:
All pregnant women with hypertension should have a proper diagnostic workup and be treated appropriately. In women with mild hypertension, BP therapeutic target should be set to 110-140/80-85mmHg. In women with severe hypertension, BP should be reduced by at least 25% as soon as possible, and gradually thereafter to normal target levels of <140/105mmHg. In terms of preeclampsia, physicians need to consider potential complications and formulate prevention strategies. The choice of antihypertensive medication is crucial since certain classes can be detrimental to the fetus and should be avoided. Post-partum, the choice of antihypertensive therapy of the mother should take into consideration breastfeeding of the fetus. Given the life-long cardiovascular risk of women with pregnancy hypertension, a regular cardiovascular evaluation is in order.
Conclusion:
Albeit the antihypertensive treatment exerts significant benefits for both the mother and the baby, several clinical aspects remain un-tackled. More research is needed to further improve the treatment of such disorders.
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