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Should All Patients with Resistant Hypertension Receive Spironolactone?

  • Resistant Hypertension (E Pimenta, Section Editor)
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Abstract

Purpose of review

Resistant hypertension is a common clinical situation. Identification of true resistant hypertension (using 24-h ambulatory blood pressure monitoring to exclude white coat phenomenon, excluding secondary causes and non-adherence to treatment) is important mostly because of the application of a proper therapeutic approach and the higher cardiovascular risk of these patients. This review surveys recent studies, with a focus on mineralocorticoid receptor antagonists, including spironolactone, in the treatment of resistant hypertension.

Recent findings

A range of randomized and non-randomized studies have proved the efficacy of mineralocorticoid receptor antagonists, including spironolactone. However, long-term mortality studies are still missing for the hypertensive population. In the case of spironolactone side effects, higher doses of amiloride or eplerenone might be used.

Summary

Based on available data and our own experience, spironolactone (mineralocorticoid receptor antagonists) should be involved, if tolerated, in combination therapy in true resistant hypertensive patients. Spironolactone still represents primary therapeutic modality under specific conditions of primary aldosteronism.

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Acknowledgments

The manuscript was supported by Charles University research projects UNCE 204010 and PRVOUK P35 and a research project of the Ministry of Health of the Czech Republic, grant no. 16-30345A.

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Authors and Affiliations

  1. 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic

    Ján Rosa, Tomáš Zelinka, Ondřej Petrák, Branislav Štrauch, Robert Holaj & Jiří Widimský Jr

  2. Cardiocenter, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic

    Ján Rosa

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  1. Ján Rosa
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Rosa, J., Zelinka, T., Petrák, O. et al. Should All Patients with Resistant Hypertension Receive Spironolactone?. Curr Hypertens Rep 18, 81 (2016). https://doi.org/10.1007/s11906-016-0690-1

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