Treating resistant hypertension: Taking stubborn high blood pressure down a notch

The study compares the effectiveness of two drugs commonly used for resistant hypertension at lowering blood pressure and reducing left ventricular mass. 

There are a variety of different medications available to treat high blood pressure. However, a percentage of patients do not effectively respond to the common medications for high blood pressure. This is known as resistant hypertension. Patients with resistant hypertension must have alternative drugs added to their standard treatment. These alternatives include mineralocortoicoid receptor blockers (MRB, such as spironolactone [Aldactone]) and renin angiotension system blockers (RASB, such as ramipril [Altace]).

MRBs and RASBs decrease the mass (size) of the left ventricle (a chamber in the heart). Increased left ventricular mass increases the risk of cardiovascular (heart) disease. It is not clear which treatment is most effective at reducing left ventricular mass.

This study compared the effectiveness of MRBs and RASBs when added to standard treatment in patients with resistant hypertension.

This was a 12-week study including 167 patients. For the first 4 weeks, patients were treated with medications normally used for high blood pressure (such as diuretics). If after 4 weeks blood pressure readings were still high (135/85 mmHg or above), patients were considered to have resistant high blood pressure. These patients were randomly assigned to receive spironolactone or ramipril in addition to the previous treatments. An additional MRB or RASB was added if needed after 4 weeks of treatment. Left ventricular mass was measured using echocardiogram (a type of ultrasound that uses sound waves to produce images of the heart beating). 

The addition of MRBs decreased blood pressure further (by an average of 12/5 mmHg) than did the addition of RASBs. The left ventricular mass decreased by 8.2 g/m with the addition of MRBs compared to an increase of 1.8 g/m with the addition of RASBs.

This study concluded that treatment with MRBs was more effective at reducing both blood pressure and left ventricular mass index then treatment with RASBs. 

12 weeks is a very short time period and the numbers included in the study were not very large. A further study with a larger number of participants over a longer period of time would produce more accurate results. 

Before altering the medications you are taking, you should consult with your doctor.