Comparing aldosterone antagonists and renin-guided therapy for resistant hypertension

This study compared the effectiveness of aldosterone antagonists and renin-guided therapy in patients with resistant hypertension. The authors concluded that both aldosterone agonists and renin-guided therapy are effective at lowering blood pressure in patients with resistant hypertension. 

Patients with resistant hypertension have a blood pressure level that is consistently higher than 140/90 mm Hg. Resistant hypertension usually requires treatment with 3 or more drugs. The number of patients taking 3 or more medications for hypertension has risen from 16% to 28% in the last number of years.

Aldosterone antagonists are a type of diuretic treatment for hypertension. They cause the body to produce more urine, and urinate more frequently. This reduces the blood pressure by reducing the amount of fluid in the body. Renin is an enzyme that is involved in the regulation of blood pressure. Treatment for hypertension can be more or less effective depending on the levels of renin in the blood. Renin-guided therapy is a strategy where renin levels are measured to determine the most effective treatment. Both of these treatments have been effective at lowering blood pressure in patients with hypertension. Which is more effective for patients with resistant hypertension is still being studied.

89 patients with resistant hypertension from 4 treatment centers were included in this study. Patients were required to be taking at least 3 different medications for hypertension. Patients were randomly assigned to receive treatment with either aldosterone antagonists or renin-guided therapy. Patients were followed for up to 6 study visits over a 6-month period. Blood pressure levels were measured at each visit.

Changes in blood pressure were similar across the two treatment groups. Systolic blood pressure (SBP – pressure when the heart is contracting) was lowered by 20.4 mm Hg in the renin-guided therapy group. It was lowered by 17.6 mm Hg in the aldosterone antagonists group. Diastolic blood pressure (DBP – pressure when the heart is between beats) was lowered by 9.7 mm Hg in the renin-guided therapy group. It was lowered by 4.0 mm Hg in the aldosterone antagonists group.

The number of additional treatments required was higher in the aldosterone antagonists group than in the renin-guided therapy group. Two serious side effects were reported during the study. One patient in the aldosterone antagonists group reported headaches, blurred vision, and vomiting. One case of heart failure was observed in the renin-guided therapy group.

The authors concluded that both aldosterone agonists and renin-guided therapy are effective at lowering blood pressure in patients with resistant hypertension.

Larger studies are needed to confirm these results.