Use of Aldosterone Antagonists for Treatment of Uncontrolled Resistant Hypertension
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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.
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In patients with obesity and treatment-resistant hypertension treated with spironolactone, reductions in blood pressure did not correlate with plasma aldosterone concentration.
“Moreover, in patients with obesity and treatment-resistant hypertension who were treated with spironolactone, the resulting reductions in BP did not correlate with plasma aldosterone concentration73,74.”
From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [73]
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Obesity, kidney dysfunction and hypertension: mechanistic links
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- Authors
- Dudenbostel, T., & Calhoun, D. A.
- Affiliations
- University of Alabama at Birmingham (US)
- Venue
- American Journal of Hypertension
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-09-08
- Volume
- 30
- Issue
- 2
- Pages
- 103-109
- ISSN
- 0895-7061 (ISSN-L)
- 1941-7225
- PMC
- PMC5225942
- OpenAlex
- W2516668276
- Cited by
- 51
- References
- 23
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 8 · 2021: 4 · 2020: 5 · 2019: 5 · 2018: 9 · 2017: 6 · 2016: 3
- FWCI
- 7.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Hypertension (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- University of Alabama at Birmingham
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL113004)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- mineralocorticoid receptor antagonists, resistant hypertension, primary aldosteronism, spironolactone, hyperaldosteronism, aldosterone excess, antihypertensive therapy, sodium intake, obesity, hypertension
- MeSH terms
- Mineralocorticoid Receptor Antagonists, Blood Pressure, Humans, Hypertension, Malignant
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