Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension

Krieger, E M; Drager, Luciano F.; Giorgi, Dante Marcelo Artigas; Pereira, Alexandre C.; Barreto‐Filho, José Augusto; Nogueira, Ana; Mill, José Geraldo; Lotufo, Paulo A; Amodeo, Celso; Batista, Marcelo C.; Bodanese, Luiz Carlos; Carvalho, Antonio C.C; Castro, Iran; Chaves, Hilton; Costa, Eduardo A.; Feitosa, Gílson Soares; Franco, Roberto Jorge da Silva; Fuchs, F; Guimarães, Armênio Costa; Jardim, Paulo César Veiga; Machado, Carlos A.; Magalhães, Maria Eliane Campos; Mion, Décio; Neto, Raimundo Marques do Nascimento; Nobre, Fernando; Nóbrega, Antônio C.; Ribeiro, Antônio Luiz Pinho; Rodrigues-Sobrinho, C.R.M.; Sanjuliani, Antônio Felipe; Teixeira, Mauro; Krieger, José Eduardo; Betito, Alessandro; Moia, Diogo D.F.; Souza, Silvia Beatriz Paulino Cavasin de; Júnior, Hilton de Castro Chaves

doi:10.1161/hypertensionaha.117.10662

Cited by 135 publications

(61 citation statements)

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“… IIa B [ 133 , 134 ] • Loop diuretics can be considered in patients with CHF, advanced CKD of stage IV or stage V. IIa B [ 135 ] • In patients with resistant HTN, aldosterone antagonists such as spironolactone can be considered in the absence of hyperkalemia. IIa B [ 136 , 137 ] …”

Section: Chapter II Treatment Of Hypertensionmentioning

confidence: 99%

2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension

et al. 2019

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The standardized techniques of blood pressure (BP) measurement in the clinic are emphasized and it is recommended to replace the mercury sphygmomanometer by a non-mercury sphygmomanometer. Out-of-office BP measurement using home BP monitoring (HBPM) or ambulatory BP monitoring (ABPM) and even automated office BP (AOBP) are recommended to correctly measure the patient’s genuine BP. Hypertension (HTN) treatment should be individualized based on cardiovascular (CV) risk and the level of BP. Based on the recent clinical study data proving benefits of intensive BP lowering in the high risk patients, the revised guideline recommends the more intensive BP lowering in high risk patients including the elderly population. Lifestyle modifications, mostly low salt diet and weight reduction, are strongly recommended in the population with elevated BP and prehypertension and all hypertensive patients. In patients with BP higher than 160/100 mmHg or more than 20/10 mmHg above the target BP, two drugs can be prescribed in combination to maximize the antihypertensive effect and to achieve rapid BP control. Especially, single pill combination drugs have multiple benefits, including maximizing reduction of BP, minimizing adverse effects, increasing adherence, and preventing cardiovascular disease (CVD) and target organ damage.

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Section: Chapter II Treatment Of Hypertensionmentioning

confidence: 99%

2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension

et al. 2019

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“…36 The second observation is that many patients with resistant hyperten sion can actually be conrolled using the pre scription of spironolactone as the fourthline therapy after diuretics, calcium antagonists, and RAS blockers. [37][38][39][40] Thus, the real need for an interventional therapy decreased signifi cantly as more precise data on resistant hy pertension were gathered.…”

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confidence: 99%

Controversies in the management of patients with arterial hypertension

Burnier

2019

Kardiol Pol

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“…Data from clinical studies of spironolactone versus central acting drugs Although concrete evidence supports the superiority of mineralocorticoid receptor antagonists over alpha-and beta-blockers for patients with resistant hypertension, there is a lack of evidence regarding the use of central acting drugs in such patients. In this setting, the recent Resistant Hypertension Optimal Treatment (ReHOT) study compared the impact of spironolactone and clonidine in 187 patients with resistant hypertension 16 . BP control assessed with office and 24-hour ambulatory BP monitoring was similar across the two groups of patients.…”

Section: Recent Advances In Pharmacological Therapymentioning

confidence: 99%

“…Meta-analytic data of mineralocorticoid antagonists versus other drug classes Important information emerged from meta-analytic data for the use of mineralocorticoid receptor antagonists in patients with resistant hypertension. In 869 patients from four trials, spironolactone as add-on therapy was associated with a reduction in BP of 16.67/6.11 mm Hg 16 . A meta-analysis of 662 patients and five trials found that the addition of spironolactone in patients with resistant hypertension resulted in a reduction in office BP levels of 15.73/6.21 mm Hg compared with placebo, but compared with other drugs (beta-blocker, candesartan, or alpha methyldopa), spironolactone reduced home systolic BP by 4.5 mm Hg 18 .…”

Section: Recent Advances In Pharmacological Therapymentioning

confidence: 99%

Recent advances in understanding and managing resistant/refractory hypertension

et al. 2020

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The management of resistant hypertension presents several challenges in everyday clinical practice. During the past few years, several studies have been performed to identify efficient and safe pharmacological and non-pharmacological options for the management of such patients. The Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2) trial demonstrated significant benefits with the use of spinorolactone as a fourth-line drug for the treatment of resistant hypertension over doxazosin and bisoprolol. In addition, recent data support that spironolactone may demonstrate superiority over central acting drugs in such patients, as well. Based on the European guidelines, spironolactone is recommended as the fourth-line drug option, followed by amiloride, other diuretics, doxazosin, bisoprolol or clonidine. Among several device-based approaches, renal sympathetic denervation had fallen into hibernation after the disappointing results of the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN) 3 trial. However, the technique re-emerged at the epicenter of the clinical and research interest after the favorable results of three sham-controlled studies, which facilitated novel catheters and techniques to perform the denervation. Significant results of iliac anastomosis on blood pressure levels have also been demonstrated. Nevertheless, the technique-related adverse events resulted in withdrawal of this interventional approach. Last, the sympatholytic properties of the carotid baroreceptor activation therapy were associated with significant blood pressure reductions in patients with resistant hypertension, which need to be verified in larger controlled trials. Currently device-based approaches are recommended only in the setting of clinical trials until more safety and efficacy data become available.

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Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension

Abstract: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01643434.

Cited by 135 publications

References 24 publications

2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension

2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension

Controversies in the management of patients with arterial hypertension

Recent advances in understanding and managing resistant/refractory hypertension

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