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Spironolactone resistant hypertension

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https://www.readbyqxmd.com/read/28448185/addition-of-spironolactone-in-patients-with-resistant-hypertension-a-meta-analysis-of-randomized-controlled-trials
#1
Liping Liu, Bing Xu, Yunfeng Ju
This study was designed to assess the effect of additional spironolactone on blood pressure in patients with resistant hypertension. MEDLINE, EMBASE, and Cochrane Library were searched to identify randomized controlled trials (RCTs) that determined the effect of add-on spironolactone on blood pressure in patients with resistant hypertension compared with a control group. A total of five RCTs met the inclusion criteria. Spironolactone reduced office systolic blood pressure (SBP) by 15.73 mmHg (95% CI -20.45 to -11...
2017: Clinical and Experimental Hypertension: CHE
https://www.readbyqxmd.com/read/28443356/sham-or-no-sham-control-that-is-the-question-in-trials-of-renal-denervation-for-resistant-hypertension-a-systematic-meta-analysis
#2
Fadl Elmula M Fadl Elmula, Ying-Mei Feng, Lotte Jacobs, Anne C Larstorp, Sverre E Kjeldsen, Alexandre Persu, Jan A Staessen
BACKGROUND: Studies of renal denervation (RDN) in patients with apparent treatment resistant hypertension have been hampered by a number of patient and physician related confounders on blood pressure (BP) including poor drug adherence. It remains uncertain whether RDN lowers BP. We aimed to investigate whether the use of sham control is essential in RDN studies or whether systematic use of 24-hour ambulatory BP provides enough information thereby making an invasive sham control redundant...
April 26, 2017: Blood Pressure
https://www.readbyqxmd.com/read/28349274/a-systematic-review-of-add-on-pharmacologic-therapy-in-the-treatment-of-resistant-hypertension
#3
REVIEW
Anita P Tataru, Arden R Barry
INTRODUCTION: The objective of this systematic review was to evaluate the efficacy and safety of add-on pharmacologic therapies in the treatment of resistant hypertension (RH), defined as blood pressure (BP) above target despite three antihypertensive agents. METHODS: A systematic search was performed in MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and Google Scholar (inception to June 2016) to identify randomized controlled trials (RCTs) that compared any antihypertensive agent with control in patients with RH...
March 27, 2017: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
https://www.readbyqxmd.com/read/28327653/association-of-aldosterone-excess-and-apnea-hypopnea-index-in-patients-with-resistant-hypertension
#4
Xiao Ke, Wenyu Guo, Hu Peng, Chengheng Hu, Henghong Zhang, Changnong Peng, Xiaoqing Wang
The present study was to investigate the association of aldosterone excess and apnea-hypopnea index (AHI) in patients with resistant hypertension. Patients with resistant hypertension were enrolled and baseline characteristics including plasma aldosterone concentration (PAC) and 24 h-urine aldosterone levels were collected and compared between groups with different degrees of AHI as assessed by polysomnography. Association of key variables and AHI was then evaluated by univariate and multiple linear regression analysis...
March 22, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28275946/a-network-meta-analysis-of-clinical-management-strategies-for-treatment-resistant-hypertension-making-optimal-use-of-the-evidence
#5
Peter Makai, Joanna IntHout, Jaap Deinum, Kevin Jenniskens, Gert Jan van der Wilt
BACKGROUND: With the addition of surgical interventions to current medicinal treatments, it is increasingly challenging for clinicians to rationally choose among the various options for treating patients with apparent treatment-resistant hypertension (ATRHTN). This study aims to establish the comparative effectiveness of mineralocorticoid receptor antagonists (MRA), renal denervation (RDN), darusentan and central arteriovenous anastomosis (CAA) for patients with ATRHTN by performing a network meta-analysis...
March 8, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28236585/the-importance-of-genetic-counseling-and-genetic-screening-a-case-report-of-a-16-year-old-boy-with-resistant-hypertension-and-severe-hypokalemia
#6
Ze-Min Kuang, Ying Wang, Jia-Jie Wang, Jing-Hua Liu, Rong Zeng, Qi Zhou, Zhen-Qiu Yu, Long Jiang
Liddle's syndrome, an autosomal dominant form of monogenic hypertension, is characterized by salt-sensitive hypertension with early penetrance, hypokalemia, metabolic alkalosis, suppression of plasma rennin activity and aldosterone secretion, and a clear-cut response to epithelial sodium channel blockers but not spironolactone therapy. Here, we describe the case of a 16-year-old boy patient with resistant hypertension (maintain 170-180/100-110 mm Hg after administration four kinds of antiypertensive drugs) and severe hypokalemia...
February 3, 2017: Journal of the American Society of Hypertension: JASH
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
#7
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...
April 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
#8
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
#9
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
#10
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
#11
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...
April 15, 2017: 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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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