Use of Aldosterone Antagonists for Treatment of Uncontrolled Resistant Hypertension

Tanja Dudenbostel, David A Calhoun, Tanja Dudenbostel, David A Calhoun

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..

© American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

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