Low dose spironolactone exerts significant BP and urinary albumin creatinine ratio lowering effects in high-risk patients with resistant hypertension and type 2 diabetes mellitus.

No abstract

Aberrant presence of plasmin in preurine may inappropriately activate ENaC in patients with type 2 diabetes and microalbuminuria. This may contribute to treatment-resistant hypertension.

A urinary proteomics classifier can be used to identify individuals with type 2 diabetes who are more likely to show an albuminuria-lowering response to spironolactone treatment. These results suggest that urinary proteomics may be a valuable tool to tailor therapy, but confirmation in a larger clinical trial is required.

Background: It is unclear whether intensive blood pressure management is well-tolerated and affects risk uniformly across the body mass index (BMI) spectrum. Methods: The randomized, controlled Systolic Blood Pressure Intervention Trial (SPRINT) included 9,361 individuals ≥50 years at high cardiovascular risk, without diabetes mellitus, and a systolic blood pressure 130-180 mmHg. Participants were randomized to intensive versus standard antihypertensive treatment and evaluated for the primary composite efficacy endpoint of acute coronary syndromes, stroke, heart failure, or cardiovascular death. The primary safety endpoint was serious adverse events. We used restricted cubic splines to determine the relationship between BMI, response to intensive blood pressure lowering, and clinical outcomes in SPRINT. Results: BMI measurements could be calculated for 9,284 (99.2%) individuals. Mean BMI was similar between the two treatment groups (intensive group 29.9±5.8 kg/m 2 vs. standard group 29.8± 5.7 kg/m 2 ; P=0.39). Median follow-up was 3.3 years (range 0-4.8 years). BMI had a significant, Jshaped association with risk of all-cause mortality, stroke, and serious adverse events (P<0.05 for all), but these were no longer significant after accounting for key clinical factors (P>0.05 for all). Intensive blood pressure lowering reduced the primary efficacy endpoint and increased the primary safety endpoint compared with standard targets, consistently across the BMI spectrum (Pinteraction>0.05). Conclusion: The overall efficacy and safety of intensive blood pressure lowering did not appear to be modified by baseline BMI among high-risk older adults.