Skip to main content
Log in

Consider mineralocorticoid receptor antagonists as add-on therapy in treatment-resistant hypertension

  • Disease Management
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Treatment-resistant hypertension is associated with an increased risk of cardiovascular morbidity and mortality. Treatment recommendations include a combination of at least three antihypertensive drug classes, including a diuretic. Although there is limited evidence to support selection of add-on therapy, mineralocorticoid receptor antagonists (e.g. spironolactone and eplerenone) can effectively reduce blood pressure when added to standard combination therapy, and should be considered as fourth-line treatment options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72.

    Article  CAS  PubMed  Google Scholar 

  2. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117(25):e510–26.

    Article  PubMed  Google Scholar 

  3. Vega J, Bisognano JD. The prevalence, incidence, prognosis and associated conditions of resistant hypertension. Semin Nephrol. 2014;34(3):247–56.

    Article  PubMed  Google Scholar 

  4. Glicklich D, Frishman WH. Drug therapy of apparent treatment-resistant hypertension: focus on mineralocorticoid receptor antagonists. Drugs. 2015;75(5):473–85.

    Article  CAS  PubMed  Google Scholar 

  5. Gaddam KK, Nishizaka MK, Pratt-Ubunama MN, et al. Characterization of resistant hypertension: association between resistant hypertension, aldosterone, and persistent intravascular volume expansion. Arch Intern Med. 2008;168(11):1159–64.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Clark D, Ahmed MI, Calhoun DA. Resistant hypertension and aldosterone: an update. Can J Cardiol. 2012;28(3):318–25.

    Article  CAS  PubMed  Google Scholar 

  7. Vongpatanasin W. Resistant hypertension: a review of diagnosis and management. JAMA. 2014;311(21):2216–24.

    Article  PubMed  Google Scholar 

  8. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC practice guidelines for the management of arterial hypertension. Blood Press. 2014;23(1):3–16.

    Article  PubMed  Google Scholar 

  9. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the 8th Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.

    Article  CAS  PubMed  Google Scholar 

  10. Gorostidi M, de la Sierra A. Combination therapy in hypertension. Adv Ther. 2013;30(4):320–36.

    Article  CAS  PubMed  Google Scholar 

  11. Ernst ME, Lund BC. Renewed interest in chlorthalidone: evidence from the Veterans Health Administration. J Clin Hypertens. 2010;12(12):927–34.

    Article  CAS  Google Scholar 

  12. Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359(23):2417–28.

    Article  CAS  PubMed  Google Scholar 

  13. Jansen PM, Danser AH, Imholz BP, et al. Aldosterone-receptor antagonism in hypertension. J Hypertens. 2009;27(4):680–91.

    Article  CAS  PubMed  Google Scholar 

  14. Kasama S, Toyama T, Kumakura H, et al. Effect of spironolactone on cardiac sympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy. J Am Coll Cardiol. 2003;41(4):574–81.

    Article  CAS  PubMed  Google Scholar 

  15. Hirsch JS, Drexler Y, Bomback AS. Aldosterone blockade in chronic kidney disease. Semin Nephrol. 2014;34(3):307–22.

    Article  CAS  PubMed  Google Scholar 

  16. Gaddam K, Pimenta E, Thomas SJ, et al. Spironolactone reduces severity of obstructive sleep apnea in patients with resistant hypertension: a preliminary report. J Hum Hypertens. 2010;24(8):532–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Chapman N, Dobson J, Wilson S, et al. Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension. 2007;49(4):839–45.

    Article  CAS  PubMed  Google Scholar 

  18. Václavík J, Sedlák R, Plachy M, et al. Addition of spironolactone in patients with resistant arterial hypertension (ASPIRANT): a randomized, double-blind, placebo-controlled trial. Hypertension. 2011;57(6):1069–75.

    Article  PubMed  Google Scholar 

  19. Abolghasmi R, Taziki O. Efficacy of low dose spironolactone in chronic kidney disease with resistant hypertension. Saudi J Kidney Dis Transplant. 2011;22(1):75–8.

    Google Scholar 

  20. Oxlund CS, Henriksen JE, Tarnow L, et al. Low dose spironolactone reduces blood pressure in patients with resistant hypertension and type 2 diabetes mellitus: a double blind randomized clinical trial. J Hypertens. 2013;31(10):2094–102.

    Article  CAS  PubMed  Google Scholar 

  21. Karns AD, Bral JM, Hartman D, et al. Study of aldosterone synthase inhibition as an add-on therapy in resistant hypertension. J Clin Hypertens. 2013;15(3):186–92.

    Article  CAS  Google Scholar 

  22. Yoshitomi Y, Kawanishi K-I, Yamaguchi A, et al. Effectiveness of the direct renin inhibitor, aliskiren, in patients with resistant hypertension. Int Heart J. 2013;54(2):88–92.

    Article  CAS  PubMed  Google Scholar 

  23. Harel Z, Gilbert C, Wald R, et al. The effect of combination treatment with aliskiren and blockers of the renin-angiotensin system on hyperkalaemia and acute kidney injury: systematic review and meta-analysis. BMJ. 2012;344:e42.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Robles NR, Cerezo I, Hernandez-Gallego R. Renin-angiotensin system blocking drugs. J Cardiovasc Pharmacol Ther. 2014;19(1):14–33.

    Article  CAS  PubMed  Google Scholar 

  25. Amar L, Azizi M, Menard J, et al. Aldosterone synthase inhibition with LCI699: a proof-of-concept study in patients with primary aldosteronism. Hypertension. 2010;56(5):831–8.

    Article  CAS  PubMed  Google Scholar 

  26. Calhoun DA, White WB, Krum H, et al. Effects of a novel aldosterone synthase inhibitor for treatment of primary hypertension: results of a randomized, double-blind, placebo- and active-controlled phase 2 trial. Circulation. 2011;124(18):1945–55.

    Article  CAS  PubMed  Google Scholar 

  27. Monge M, Lorthioir A, Bobrie G, et al. New drug therapies interfering with the renin-angiotensin-aldosterone system for resistant hypertension. J Renin Angiotensin Aldosterone Syst. 2013;14(4):285–9.

    Article  CAS  PubMed  Google Scholar 

  28. Bhatt DL, Kandzari DE, O’Neill WW, et al. A controlled trial of renal denervation for resistant hypertension. N Engl J Med. 2014;370(15):1393–401.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Consortia

Ethics declarations

Disclosure

This article was adapted from Drugs 2015;75(5):473–85 [4] by salaried employees of Adis/Springer and was not supported by any external funding.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adis Medical Writers. Consider mineralocorticoid receptor antagonists as add-on therapy in treatment-resistant hypertension. Drugs Ther Perspect 31, 345–349 (2015). https://doi.org/10.1007/s40267-015-0229-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-015-0229-6

Keywords

Navigation