Eplerenone Versus Spironolactone in Resistant Hypertension: an Efficacy and/or Cost or Just a Men’s Issue?

Manolis, Antonis A.; Manolis, Theodora A.; Melita, Helen; Manolis, Antonis S

doi:10.1007/s11906-019-0924-0

Cited by 30 publications

(24 citation statements)

References 104 publications

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“…8,71,110 If spironolactone is contraindicated or not tolerated, amiloride, doxazosin, eplerenone, clonidine, and beta-blockers are alternatives, or any available antihypertensive class not already in use. 1,[111][112][113][114] • Resistant hypertension should be managed in specialist centers with sufficient expertize, and resources necessary to diagnose and treat this condition. 115…”

Section: Recommendationsmentioning

confidence: 99%

2020 International Society of Hypertension Global Hypertension Practice Guidelines

et al. 2020

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Section: Recommendationsmentioning

confidence: 99%

2020 International Society of Hypertension Global Hypertension Practice Guidelines

et al. 2020

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“…Such aldosteronism most commonly exists separately from and independent of angiotensin II. [ 20 ] The aldosterone-induced volume excess is placed at the root of the development of RH in a large number of patients, with primary aldosteronism being present in approximately 20% of patients. [ 21 ] Some studies reported that aldosterone could predict new hypertension, type 2 diabetes mellitus, central obesity, and the use of lipid-lowering drugs in the general community and remained associated with hypertension, obesity, and CKD over 4 years.…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy and safety of spironolactone in patients with resistant hypertension

et al. 2020

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Background: We conducted a meta-analysis to summarize all available evidence from randomized controlled trial studies regarding the clinical efficacy and safety of spironolactone in patients with resistant hypertension (RH) and provided a quantitative assessment. Methods: A systematic search of PubMed, Web of Science, Cochrane Library, Embase, and China National Knowledge Infrastructure (CNKI) databases through December 8, 2019, was performed. Randomized controlled trials randomized controlled trials meeting inclusion criteria were included to assess the effect of the addition of spironolactone on office blood pressure (BP), 24-hour ambulatory BP or adverse events in RH patients. Results: Twelve trials, which enrolled a total of 1655 patients, were included in this meta-analysis. In comparison with placebo, spironolactone significantly reduced office BP (office SBP, weighted mean difference [WMD] = −20.14, 95% CI = −31.17 to −9.12, P < .001; office DBP WMD = −5.73, 95% CI = −8.13 to −3.33, P < .001) and 24-hour ambulatory BP (ASBP, WMD = −10.31, 95% CI = −12.86 to −7.76, P < .001; ADBP, WMD = −3.94, 95% CI = −5.50 to −2.37, P < .001). Compared with alternative drugs, spironolactone treatment in RH patients significantly decreased 24-hour ambulatory BP (ASBP, WMD = −6.98, 95% CI = −12.66 to −1.30, P < .05; ADBP, WMD = −3.03, 95% CI = −5.21 to −0.85, P < .001). Conclusion: This meta-analysis fully evaluated the antihypertensive effect of spironolactone compared with placebo, alternative drugs, renal nerve denervation and no treatment. Spironolactone can result in a substantial BP reduction in patients with RH at 3 months.

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“…40 In human hypertension, spironolactone is mainly indicated for resistant hypertension. 41 The sixth experimental group received a combination of fasudil (25 mg/kg/day) + HCTZ (4 mg/kg/day) by gavage for 3 weeks. Thus, 6 experimental groups were compared after 6 weeks.…”

Section: Methodsmentioning

confidence: 99%

Hydrochlorothiazide Reduces Cardiac Hypertrophy, Fibrosis and Rho-Kinase Activation in DOCA-Salt Induced Hypertension

Mondaca‐Ruff

Araos

Yáñez

et al. 2021

J Cardiovasc Pharmacol Ther

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Background: Thiazides are one of the most common antihypertensive drugs used for hypertension treatment and hydrochlorothiazide (HCTZ) is the most frequently used diuretic for hypertension treatment. The Rho/Rho-kinase (ROCK) path plays a key function in cardiovascular remodeling. We hypothesized that in preclinical hypertension HCTZ reduces myocardial ROCK activation and consequent myocardial remodeling. Methods: The preclinical model of deoxycorticosterone (DOCA)-salt hypertension was used (Sprague–Dawley male rats). After 3 weeks, in 3 different groups: HCTZ, the ROCK inhibitor fasudil or spironolactone was added (3 weeks). After 6 weeks myocardial hypertrophy and fibrosis, cardiac levels of profibrotic proteins, mRNA levels (RT PCR) of pro remodeling and pro oxidative molecules and ROCK activity were determined. Results: Blood pressure, myocardial hypertrophy and fibrosis were reduced significantly by HCTZ, fasudil and spironolactone. In the heart, increased levels of the pro-fibrotic proteins Col-I, Col-III and TGF-β1 and gene expression of pro-remodeling molecules TGF-β1, CTGF, MCP-1 and PAI-1 and the pro-oxidative molecules gp91phox and p22phox were significantly reduced by HCTZ, fasudil and spironolactone. ROCK activity in the myocardium was increased by 54% ( P < 0.05) as related to the sham group and HCTZ, spironolactone and fasudil, reduced ROCK activation to control levels. Conclusions: HCTZ reduced pathologic LVH by controlling blood pressure, hypertrophy and myocardial fibrosis and by decreasing myocardial ROCK activation, expression of pro remodeling, pro fibrotic and pro oxidative genes. In hypertension, the observed effects of HCTZ on the myocardium might explain preventive outcomes of thiazides in hypertension, specifically on LVH regression and incident heart failure.

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Eplerenone Versus Spironolactone in Resistant Hypertension: an Efficacy and/or Cost or Just a Men’s Issue?

Cited by 30 publications

References 104 publications

2020 International Society of Hypertension Global Hypertension Practice Guidelines

2020 International Society of Hypertension Global Hypertension Practice Guidelines

Clinical efficacy and safety of spironolactone in patients with resistant hypertension

Hydrochlorothiazide Reduces Cardiac Hypertrophy, Fibrosis and Rho-Kinase Activation in DOCA-Salt Induced Hypertension

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