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Spironolactone resistant hypertension

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https://www.readbyqxmd.com/read/28129246/effects-of-continuous-positive-airway-pressure-treatment-on-aldosterone-excretion-in-patients-with-obstructive-sleep-apnoea-and-resistant-hypertension-a-randomized-controlled-trial
#1
Fabio de Souza, Elizabeth S Muxfeldt, Victor Margallo, Arthur F Cortez, Aline H Cavalcanti, Gil F Salles
OBJECTIVE: Aldosterone excess has been equally associated with resistant hypertension (RHT) and obstructive sleep apnoea (OSA). We conducted a randomized controlled study to assess the effect of continuous positive airway pressure (CPAP) treatment on 24-h urinary aldosterone excretion in patients with RHT and moderate/severe OSA. METHODS: A total of 117 patients were randomized (57 CPAP and 60 control groups). Aldosterone excretion was determined by 24 h urine (24h-UAldo) collected at randomization and after 6 months of follow-up...
January 27, 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28123500/effects-of-low-dose-tolvaptan-on-electrolyte-abnormality-and-hemodynamic-parameters-in-a-liver-cirrhosis-associated-portopulmonary-hypertension-patient-a-case-report
#2
Yoshito Ogihara, Norikazu Yamada, Kaoru Dohi, Akimasa Matsuda, Satoshi Ota, Ken Ishikura, Mashio Nakamura, Masaaki Ito
The present study reported a case of portopulmonary hypertension (POPH) that was secondary to underlying liver cirrhosis in a 58-year-old woman, who was successfully treated with low-dose tolvaptan. The patient had suffered from refractory peripheral edema and electrolyte abnormalities, including severe hypokalemia, under the combination therapy of sildenafil, ambrisentan, furosemide and spironolactone. Subsequent to the initiation of low-dose tolvaptan at 3.75 mg/day with concurrent de-escalation of the dose of furosemide, the daily urine volume increased, peripheral edema improved and the serum potassium level increased immediately...
January 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28118281/renal-denervation-in-comparison-with-intensified-pharmacotherapy-in-true-resistant-hypertension-2-year-outcomes-of-randomized-prague-15-study
#3
Ján Rosa, Petr Widimský, Petr Waldauf, Tomáš Zelinka, Ondřej Petrák, Miloš Táborský, Marian Branny, Petr Toušek, Karol Čurila, Lukáš Lambert, František Bednář, Robert Holaj, Branislav Štrauch, Jan Václavík, Eva Kociánová, Igor Nykl, Otakar Jiravský, Gabriela Rappová, Tomáš Indra, Zuzana Krátká, Jiří Widimský
OBJECTIVES: The randomized, multicentre study compared the efficacy of renal denervation (RDN) versus spironolactone addition in patients with true resistant hypertension. We present the 24-month data. METHODS: A total of 106 patients with true resistant hypertension were enrolled in this study: 52 patients were randomized to RDN and 54 patients to the spironolactone addition, with baseline SBP of 159 ± 17 and 155 ± 17 mmHg and average number of drugs 5...
January 23, 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/28091867/arterial-aortic-stiffness-in-patients-with-resistant-hypertension-from-assessment-to-treatment
#4
REVIEW
James E Sharman, Pierre Boutouyrie, Stéphane Laurent
PURPOSE OF REVIEW: The purpose of the review is to examine whether measurement of aortic stiffness could be especially value-adding for risk stratification and treatment among patients with resistant hypertension (RH). RECENT FINDINGS: Adverse arterial remodeling and increased aortic stiffness is associated with RH, and it may be of additional clinical benefit to measure aortic stiffness in these patients. However, there is insufficient evidence to determine whether aortic stiffness is excessively high relative to the level of blood pressure (BP) among people with RH...
January 2017: Current Hypertension Reports
https://www.readbyqxmd.com/read/28089457/a-meta-analysis-of-add-on-use-of-spironolactone-in-patients-with-resistant-hypertension
#5
Di Zhao, Hui Liu, Pingshuan Dong, Jingdong Zhao
OBJECTIVE: The efficacy of add-on use of spironolactone in patients with resistant hypertension has been investigated in several small studies. We performed this meta-analysis evaluating the efficacy of add-on use of spironolactone in these patients. METHODS: We searched Pubmed, Web of Science, and Cochrane Central for all published studies evaluating add-on use of spironolactone in patients with resistant hypertension. Only randomized controlled trials determining antihypertensive effects of spironolactone were considered...
December 29, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/28064163/predicting-albuminuria-response-to-spironolactone-treatment-with-urinary-proteomics-in-patients-with-type-2-diabetes-and-hypertension
#6
Morten Lindhardt, Frederik Persson, Christina Oxlund, Ib A Jacobsen, Petra Zürbig, Harald Mischak, Peter Rossing, Hiddo J L Heerspink
BACKGROUND: The mineralocorticoid receptor antagonist spironolactone significantly reduces albuminuria in patients with diabetes. Prior studies have shown large between-patient variability in albuminuria treatment response. We previously developed and validated a urinary proteomic classifier that predicts onset and progression of chronic kidney disease. Here, we tested whether the proteomic classifier based on 273 urinary peptides (CKD273) predicts albuminuria response to spironolactone treatment...
January 7, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27900368/whole-exome-sequencing-reveals-an-inherited-r566x-mutation-of-the-epithelial-sodium-channel-%C3%AE-subunit-in-a-case-of-early-onset-phenotype-of-liddle-syndrome
#7
Linda M Polfus, Eric Boerwinkle, Richard A Gibbs, Ginger Metcalf, Donna Muzny, Narayanan Veeraraghavan, Megan Grove, Sanjay Shete, Stephanie Wallace, Dianna Milewicz, Neil Hanchard, James R Lupski, Syed Shahrukh Hashmi, Monesha Gupta-Malhotra
To comprehensively evaluate a European-American child with severe hypertension, whole-exome sequencing (WES) was performed on the child and parents, which identified causal variation of the proband's early-onset disease. The proband's hypertension was resistant to treatment, requiring a multiple drug regimen including amiloride, spironolactone, and hydrochlorothiazide. We suspected a monogenic form of hypertension because of the persistent hypokalemia with low plasma levels of renin and aldosterone. To address this, we focused on rare functional variants and indels, and performed gene-based tests incorporating linkage scores and allele frequency and filtered on deleterious functional mutations...
November 2016: Cold Spring Harbor Molecular Case Studies
https://www.readbyqxmd.com/read/27798457/refractory-versus-resistant-hypertension
#8
Mohammed Siddiqui, David A Calhoun
PURPOSE OF REVIEW: Refractory hypertension is a recently proposed phenotype of antihypertensive treatment failure. As such it represents an extreme subtype of resistant or difficult-to-treat hypertension. Resistant hypertension is relatively common with an estimated prevalence of 10-20% of treated hypertensive patients. It is typically defined as having an uncontrolled blood pressure on three or more antihypertensive medications, including a diuretic. Refractory hypertension is rare with a prevalence of approximately 5% of patients with uncontrolled resistant hypertension...
January 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/27787836/should-all-patients-with-resistant-hypertension-receive-spironolactone
#9
REVIEW
Ján Rosa, Tomáš Zelinka, Ondřej Petrák, Branislav Štrauch, Robert Holaj, Jiří Widimský
PURPOSE OF REVIEW: Resistant hypertension is a common clinical situation. Identification of true resistant hypertension (using 24-h ambulatory blood pressure monitoring to exclude white coat phenomenon, excluding secondary causes and non-adherence to treatment) is important mostly because of the application of a proper therapeutic approach and the higher cardiovascular risk of these patients. This review surveys recent studies, with a focus on mineralocorticoid receptor antagonists, including spironolactone, in the treatment of resistant hypertension...
November 2016: Current Hypertension Reports
https://www.readbyqxmd.com/read/27777360/trends-in-antihypertensive-medication-use-among-us-patients-with-resistant-hypertension-2008-to-2014
#10
Andrew Y Hwang, Chintan Dave, Steven M Smith
Little is known of US trends in antihypertensive drug use for patients with treatment-resistant hypertension (TRH). We analyzed antihypertensive use among patients with TRH (treated with ≥4 antihypertensive drugs concurrently) from July 2008 through December 2014 using Marketscan administrative data. We included adults aged 18 to 65 years, with ≥6 months of continuous enrollment, a hypertension diagnosis, and ≥1 episode of overlapping use of ≥4 antihypertensive drugs; patients with heart failure were excluded...
December 2016: Hypertension
https://www.readbyqxmd.com/read/27754182/db-03-2-renal-sympathetic-denervation-is-still-a-viable-option-for-treating-resistant-hypertension-con
#11
George Bakris
Renal denervation started out as a very promising approach to treat resistant hypertension with a very strong conceptual and basic science frame work from Gerald DiBona's lab and extending into the early non shame clinical studies demonstrating proof of concept in SYMPLICITY HTN-1 and 2. SYMPLICITY-HTN 3 a properly done, sham control trial failed to show a benefit on further reduction of BP compared to the sham group. The conclusion the procedure doesn't work. How could this be-it was clearly effective in animal models but why not in man...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754143/os-28-01-blood-pressure-variability-in-patients-treated-with-spironolactone-or-renal-denervation-a-randomized-clinical-trial
#12
Alejandro De La Sierra, Julia Pareja, Angela Barrera, Sergi Yun, Pedro Armario, Anna Oliveras
OBJECTIVE: To compare the effect on circadian blood pressure (BP) and BP variability of treatment with sympathetic renal denervation versus spironolactone in resistant hypertensive patients. DESIGN AND METHOD: The DENERVHTA study was a randomized, open trial in 23 resistant hypertensive patients (office systolic BP > 150 and 24-hour systolic BP > 140, while on treatment with at least 3 antihypertensive drugs, one of them a diuretic). Good compliance with antihypertensive medication and eligibility of renal arteries anatomy was ensured before randomization...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754056/os-15-04-mineralocorticoid-receptor-antagonists-target-endogenous-repressor-of-hypertrophy
#13
Anastasia Mihailidou, Anthony Ashton
OBJECTIVE: Myocardial infarction (MI) continues to be a major burden of disease, despite rapid reperfusion interventions. Reperfusion of ischemic hearts (reperfusion injury) induces free radical generation, activation of early stress responses and apoptosis, which contributes to ventricular remodeling and dysfunction, which may lead to developing heart failure. Mineralocorticoid receptor (MR) antagonists have been shown clinically to reduce blood pressure, particularly in resistant hypertension, and substantially increase survival in heart failure...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754015/br-04-1management-of-treatment-resistant-hypertension
#14
David John Webb
Treatment-resistant hypertension (TRH) is defined as the failure to achieve an office BP target of <140/90 mmHg (<130/80 mmHg in patients with chronic kidney disease (CKD) or diabetes) in patients with hypertension (HT), despite adherence to at least 3 antihypertensive medications at optimal tolerated doses, ideally including a diuretic (Calhoun et al., Circulation 2008). TRH identifies patients with hard-to-treat HT, who might benefit from specialist investigation and treatment. Although some studies put the prevalence of TRH as >10%, these levels may be inflated by white-coat hypertension and poor adherence...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27754008/js-ish-esh-4-what-do-clinical-trials-teach-us-about-selection-of-antihypertensive-drugs
#15
William C Cushman
Beginning with the Veterans Administration (VA) Cooperative Hypertension Study of the 1960 s, blood pressure (BP) lowering with antihypertensive medications has been shown to reduce major cardiovascular (CV) outcomes, including coronary heart disease, stroke, heart failure (HF) and CV and all-cause mortality in randomized controlled CV outcome trials. Multiple drugs were usually required in these trials to lower BP in treated participants. Medication regimens in the early trials, including the VA trial, included a thiazide-type diuretic (TTD) as initial therapy...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27753923/os-04-07-the-comparative-effectiveness-of-4th-line-anti-hypertensive-agents-in-patients-with-resistant-hypertension-a-meta-analysis
#16
Sarah-Jo Sinnott, Adrian Root, Rohini Mathur, Kathryn Mansfield, Laurie Tomlinson, Ian Douglas
OBJECTIVE: Recent evidence points to the effectiveness of spironolactone vs placebo in the treatment of resistant hypertension (RH). However, placebo is rarely a realistic treatment choice in uncontrolled hypertension. Using meta-analysis, we assessed the effectiveness of alternative 4 line anti-hypertensive agents in comparison to 4 line spironolactone/eplenerone in RH. DESIGN AND METHOD: Pubmed, EMBASE and the Cochrane library were systematically searched for randomised and non-randomised studies that compared any 4 line anti-hypertensive agent to spironolactone/eplenerone in RH...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27753817/ssa-05-4-differences-in-management-of-hypertension-between-ethnic-groups
#17
Brian Rayner
Although the consequences of hypertension are universal, Blacks (African Americans or Indigenous Africans) have been the subject of a differential approach to causation, outcome and treatment. Blacks have a greater propensity to salt sensitivity and suppressed plasma renin suggesting a predisposition to Na retention by the kidney. As a result blood pressure (BP) response to diuretics and amlodipine is better than inhibitors of the renin-angiotensin-system in monotherapy. Target organ damage is more frequent and blood pressure (BP) is more difficult to control despite more intensive therapy...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27650995/renal-denervation-vs-spironolactone-in-resistant-hypertension-effects-on-circadian-patterns-and-blood-pressure-variability
#18
Alejandro de la Sierra, Julia Pareja, Pedro Armario, Ángela Barrera, Sergi Yun, Susana Vázquez, Laia Sans, Julio Pascual, Anna Oliveras
BACKGROUND: Sympathetic renal denervation (SRD) has been proposed as a therapeutic alternative for patients with resistant hypertension not controlled on pharmacological therapy. Two studies have suggested an effect of SRD in reducing short-term blood pressure variability (BPV). However, this has not been addressed in a randomized comparative trial. We aimed to compare the effects of spironolactone and SRD on circadian BP and BPV. METHODS: This is a post-hoc analysis of a randomized trial in 24 true resistant hypertensive patients (15 men, 9 women; mean age 64 years) comparing 50mg of spironolactone (n = 13) vs...
January 2017: American Journal of Hypertension
https://www.readbyqxmd.com/read/27643380/ssa-05-4-differences-in-management-of-hypertension-between-ethnic-groups
#19
Brian Rayner
Although the consequences of hypertension are universal, Blacks (African Americans or Indigenous Africans) have been the subject of a differential approach to causation, outcome and treatment. Blacks have a greater propensity to salt sensitivity and suppressed plasma renin suggesting a predisposition to Na retention by the kidney. As a result blood pressure (BP) response to diuretics and amlodipine is better than inhibitors of the renin-angiotensin-system in monotherapy. Target organ damage is more frequent and blood pressure (BP) is more difficult to control despite more intensive therapy...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27643316/os-04-07-the-comparative-effectiveness-of-4th-line-anti-hypertensive-agents-in-patients-with-resistant-hypertension-a-meta-analysis
#20
Sarah-Jo Sinnott, Adrian Root, Rohini Mathur, Kathryn Mansfield, Laurie Tomlinson, Ian Douglas
OBJECTIVE: Recent evidence points to the effectiveness of spironolactone vs placebo in the treatment of resistant hypertension (RH). However, placebo is rarely a realistic treatment choice in uncontrolled hypertension. Using meta-analysis, we assessed the effectiveness of alternative 4 line anti-hypertensive agents in comparison to 4 line spironolactone/eplenerone in RH. DESIGN AND METHOD: Pubmed, EMBASE and the Cochrane library were systematically searched for randomised and non-randomised studies that compared any 4 line anti-hypertensive agent to spironolactone/eplenerone in RH...
September 2016: Journal of Hypertension
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