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Review
. 2017 Feb;30(2):103-109.
doi: 10.1093/ajh/hpw105. Epub 2016 Sep 8.

Use of Aldosterone Antagonists for Treatment of Uncontrolled Resistant Hypertension

Tanja Dudenbostel  1 , David A Calhoun  2
Affiliations
Review

Use of Aldosterone Antagonists for Treatment of Uncontrolled Resistant Hypertension

Tanja Dudenbostel et al. Am J Hypertens. 2017 Feb.

Abstract

Background: Multiple studies indicate that primary aldosteronism (PA) is common in patients with resistant hypertension, with an estimated prevalence of approximately 20%. Additional studies suggest that beyond this 20% of patients with classical PA, there is a larger proportion of patients with lesser degrees of hyperaldosteronism which contributes even more broadly to antihypertensive treatment resistance. Given these observations, it is intuitive that use of aldosterone antagonists will provide antihypertensive benefit in patients with resistant hypertension and evidence of aldosterone excess. Intriguingly, however, are clinical findings demonstrating substantive benefit of aldosterone antagonists in patients with resistant hypertension, but without demonstrative evidence of hyperaldosteronism, that is, with seemingly normal or even low aldosterone levels.

Conclusion: Spironolactone is clearly established as the most effective fourth agent for treatment of uncontrolled resistant hypertension. Emerging observations suggest a further role of spironolactone for counteracting the effects of diet high in sodium, particularly in obese, hypertensive patients.

Keywords: aldosterone; aldosterone antagonists; blood pressure; hypertension; obesity; resistant hypertension; spironolactone..

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Figures

Figure 1.
Figure 1.
Spironolactone-induced reduction in SBP (filled bars) and DBP (open bars) at 6-week, 3-month, and 6-month follow-up in subjects with resistant hypertension (upper panel). Spironolactone-induced reduction in SBP and DBP at 6-week, 3-month, and 6-month follow-up in subjects with PA (filled bars) and without PA (non-PA: open bars)(lower panel). Abbreviations: DBP, diastolic blood pressure; PA, primary aldosteronism; SBP, systolic blood pressure.
Figure 2.
Figure 2.
Mean 24-hour UAldo levels to quartiles of BMI in men vs. women. White columns represent women and black columns represent men. Abbreviations: BMI, body mass index; Ualdo, urinary aldosterone
See this image and copyright information in PMC

Comment in

References

    1. Calhoun DA, Nishizaka MK, Zaman MA, Thakkar RB, Weissmann P. Hyperaldosteronism among Black and White subjects with resistant hypertension. Hypertension 2002; 40:892–896. - PubMed
    1. Eide IK, Torjesen PA, Drolsum A, Babovic A, Lilledahl NP. Low-renin status in therapy-resistant hypertension: a clue to efficient treatment. J Hypertens 2004; 22:2217–2226. - PubMed
    1. Gallay BJ, Ahmad S, Xu L, Toivola B, Davidson RC. Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone-renin ratio. Am J Kidney Dis 2001; 37:699–705. - PubMed
    1. Strauch B, Zelinka T, Hampf M, Bernhardt R, Widimsky J., Jr Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region. J Hum Hypertens 2003; 17:349–352. - PubMed
    1. Gaddam KK, Nishizaka MK, Pratt-Ubunama MN, Pimenta E, Aban I, Oparil S, Calhoun DA. Characterization of resistant hypertension: association between resistant hypertension, aldosterone, and persistent intravascular volume expansion. Arch Intern Med 2008; 168:1159–1164. - PMC - PubMed

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