Comparing alternative treatments for resistant hypertension

This study compared the effectiveness of spironolactone (Aldactone) and renal denervation treatment in patients with resistant hypertension. The authors concluded that spironolactone was more effective at reducing blood pressure than renal denervation in patients with resistant hypertension.  

Resistant hypertension, where blood pressure is consistently higher than 140/90 mm Hg, usually requires treatment with three or more drugs. If a patient’s blood pressure is not decreased with three treatments, either spironolactone or renal denervation may be prescribed as a fourth form of treatment.

Renal denervation is a procedure where nerve endings near the kidney are disrupted with small radio pulses. This procedure is minimally invasive and has been shown to reduce blood pressure levels in resistant hypertension.

Spironolactone is a type of diuretic drug. Diuretics 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. It is not clear which of these treatments is more effective at lowering blood pressure in patients with resistant hypertension.

24 patients with resistant hypertension were included in this study. Patients were randomly assigned to receive either spironolactone or renal denervation therapy. After 6 months, 24-hour systolic blood pressure (SBP – pressure when the heart is contracting) and diastolic blood pressure (DBP – pressure when the heart is between beats) were measured. Office blood pressure levels (measurements taken in a doctor’s office) were also recorded.

SBP was reduced by an additional 17.9 mm Hg in patients taking spironolactone compared to renal denervation. DBP was reduced by an additional 6.6 mm Hg in patients taking spironolactone compared to renal denervation.

Office SBP was reduced by an additional 12.1 mm Hg in patients taking spironolactone compared to renal denervation. Office DBP was reduced by an additional 5.3 mm Hg in patients taking spironolactone compared to renal denervation. 

Spironolactone was more commonly associated with reduced kidney function (based on blood tests) than renal denervation. However, kidney failure was not observed in any patients. Low sodium levels, muscle cramps, and temporary low blood pressure was also associated with spironolactone. Renal denervation was associated with mild bruising in the groin and temporary low blood pressure.

This study concluded that spironolactone is more effective than renal denervation in reducing blood pressure in patients with resistant hypertension. The authors recommend that spironolactone can be prescribed as a fourth treatment for patients if it is well-tolerated.

The number of patients included in this study is small and further studies are needed to make definite conclusions.