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Spironolactone for hypertension

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https://www.readbyqxmd.com/read/29753419/severe-renal-failure-and-thrombotic-microangiopathy-induced-by-malignant-hypertension-successfully-treated-with-spironolactone
#1
H M Villafuerte Ledesma, J M Peña Porta, P Iñigo Gil, P Martin Azara, J E Ruiz Lalglesia, A Tomás LaTorre, A Martínez Burillo, P Vernet Perna, R Álvarez Lipe
Malignant hypertension can cause thrombotic microangiopathy (TMA) characterized by hemolytic anemia and thrombocytopenia. On the other hand, severe hypertension is sometimes associated with hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP). Distinguishing these entities is important because of therapeutic implications. Plasmapheresis should be initiated as soon as possible if we are dealing with TTP. We describe the case of a 30-year-old man referred to our hospital with malignant hypertension, severe renal failure and TMA: haemoglobin=9g/dL, total bilirubin=0...
May 9, 2018: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29692992/tolvaptan-for-primary-aldosteronism-and-autosomal-dominant-polycystic-kidney-disease-a-case-report
#2
Kyohei Kunizawa, Junichi Hoshino, Hiroki Mizuno, Tatsuya Suwabe, Keiichi Sumida, Masahiro Kawada, Masayuki Yamanouchi, Akinari Sekine, Noriko Hayami, Rikako Hiramatsu, Eiko Hasegawa, Naoki Sawa, Kenmei Takaichi, Shigeru Shibata, Yoshifumi Ubara
A 59-year-old Japanese woman was admitted for evaluation of muscle weakness. Autosomal dominant polycystic kidney disease had been diagnosed at the age of 47 years, followed by primary aldosteronism at 53 years. At the age of 58, tolvaptan was started (60 mg/day) to treat her renal disease. After 8 months of tolvaptan therapy, hypokalemia-related muscle weakness became prominent, and hypertension became refractory. Finally, treatment with low-dose tolvaptan (30 mg/day) and high-dose spironolactone (100 mg/day) normalized serum potassium and the blood pressure...
January 2018: Case Reports in Nephrology and Dialysis
https://www.readbyqxmd.com/read/29674401/licorice-induced-apparent-mineralocorticoid-excess-compounded-by-excessive-use-of-terbutaline-and-high-water-intake
#3
Laust Frisenberg Buhl, Frederik Nørregaard Pedersen, Marianne Skovsager Andersen, Dorte Glintborg
This case highlights the clinical course of a 54-year-old male patient presenting with hypertension and long-term refractory hypokalaemia. He reported long-term malaise, fatigue and physical discomfort. Diarrhoea, vomiting, over-the-counter drugs, dietary supplements and any kind of medical abuse were all denied. Physical examination was normal. Suppressed plasma renin activity along with a low aldosterone level and elevated urinary cortisone/cortisol metabolite excretion ratio raised the suspicion of apparent mineralocorticoid excess (AME)...
April 19, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29668634/spironolactone-is-superior-to-hydrochlorothiazide-for-blood-pressure-control-and-arterial-stiffness-improvement-a-prospective-study
#4
RANDOMIZED CONTROLLED TRIAL
Yan Liu, Siping Dai, Lin Liu, Huocheng Liao, Chun Xiao
The present study is to investigate whether spironolactone is better than hydrochlorothiazide (HCTZ) for blood pressure (BP) control and arterial stiffness improvement. Five-hundred-sixty-six uncontrolled hypertensive patients with 2 different classes of antihypertensive medications treatment were enrolled. Spironolactone or HCTZ was randomly prescribed for 4 weeks. Carotid-femoral pulse wave velocity (cf-PWV) was measured at baseline and after 4 weeks' of spironolactone or HCTZ treatment. Between-group differences were evaluated, and logistic regression analysis was performed to evaluate the association of cf-PWV increase and incident resistant hypertension...
April 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29664406/racial-differences-in-characteristics-and-outcomes-of-patients-with-heart-failure-and-preserved-ejection-fraction-in-the-treatment-of-preserved-cardiac-function-heart-failure-trial
#5
Eldrin F Lewis, Brian Claggett, Amil M Shah, Jiankang Liu, Sanjiv J Shah, Inder Anand, Eileen O'Meara, Nancy K Sweitzer, Jean L Rouleau, James C Fang, Akshay S Desai, Tamrat M Retta, Scott D Solomon, John F Heitner, Thomas D Stamos, Robin Boineau, Bertram Pitt, Marc A Pfeffer
BACKGROUND: Black patients have been shown to have different baseline characteristics and outcomes compared with nonblack patients in cohort studies. However, few studies have focused on heart failure (HF) with preserved ejection fraction (HFpEF) patients. We aimed to determine the difference in cardiovascular outcomes in black and nonblack patients with HFpEF and to determine the relative efficacy and safety of spironolactone in black and nonblack patients. METHODS AND RESULTS: Patients with HFpEF, randomized to spironolactone versus placebo in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) in North and South America, were grouped according to self-described black and nonblack race...
March 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29655877/endocrine-and-haemodynamic-changes-in-resistant-hypertension-and-blood-pressure-responses-to-spironolactone-or-amiloride-the-pathway-2-mechanisms-substudies
#6
Bryan Williams, Thomas M MacDonald, Steve V Morant, David J Webb, Peter Sever, Gordon T McInnes, Ian Ford, J Kennedy Cruickshank, Mark J Caulfield, Sandosh Padmanabhan, Isla S Mackenzie, Jackie Salsbury, Morris J Brown
BACKGROUND: In the PATHWAY-2 study of resistant hypertension, spironolactone reduced blood pressure substantially more than conventional antihypertensive drugs. We did three substudies to assess the mechanisms underlying this superiority and the pathogenesis of resistant hypertension. METHODS: PATHWAY-2 was a randomised, double-blind crossover trial done at 14 UK primary and secondary care sites in 314 patients with resistant hypertension. Patients were given 12 weeks of once daily treatment with each of placebo, spironolactone 25-50 mg, bisoprolol 5-10 mg, and doxazosin 4-8 mg and the change in home systolic blood pressure was assessed as the primary outcome...
April 11, 2018: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/29588134/cardioprotective-effect-of-cerium-oxide-nanoparticles-in-monocrotaline-rat-model-of-pulmonary-hypertension-a-possible-implication-of-endothelin-1
#7
Seham Zakaria Nassar, Passainte S Hassaan, Doaa A Abdelmonsif, Samar Nabil ElAchy
AIMS: Cerium oxide nanoparticles (CeO2 NPs) have been recently introduced into the medical field for their antioxidant properties. The ability of CeO2 NPs alone or in combination with spironolactone (SP) to attenuate monocrotaline (MCT)-induced pulmonary hypertension and associated right ventricular hypertrophy was studied in rats. A special emphasis was given to endothelin-1 pathway. MATERIALS AND METHODS: Pulmonary hypertension was induced in albino rats by a single subcutaneous injection of MCT (60 mg/kg)...
March 24, 2018: Life Sciences
https://www.readbyqxmd.com/read/29558036/comparison-of-the-anticonvulsant-potency-of-various-diuretic-drugs-in-the-maximal-electroshock-induced-seizure-threshold-test-in-mice
#8
Katarzyna Załuska, Maria W Kondrat-Wróbel, Jarogniew J Łuszczki
BACKGROUND: The coexistence of seizures and arterial hypertension requires an adequate and efficacious treatment involving both protection from seizures and reduction of high arterial blood pressure. Accumulating evidence indicates that some diuretic drugs (with a well-established position in the treatment of arterial hypertension) also possess anticonvulsant properties in various experimental models of epilepsy. OBJECTIVES: The aim of this study was to assess the anticonvulsant potency of 6 commonly used diuretic drugs (i...
March 20, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
https://www.readbyqxmd.com/read/29527640/is-there-a-blood-pressure-lowering-effect-of-mras-in-heart-failure-an-overview-and-meta-analysis
#9
REVIEW
George Bazoukis, Costas Thomopoulos, Gary Tse, Costas Tsioufis
Although mineralocorticoid antagonists (MRAs) have been proposed as effective fourth-line blood pressure (BP) lowering agents in resistant hypertension, this effect in heart failure is undetermined. In this synthesis of heart failure randomized controlled trials (RCTs), we evaluated the extent of BP lowering following MRA treatment against placebo. We searched Medline and the Cochrane Collaboration Library databases from 1991 to September 2016 for RCTs, in which MRAs were compared with placebo. The quality of RCTs was assessed with Cochrane risk of bias tool...
March 12, 2018: Heart Failure Reviews
https://www.readbyqxmd.com/read/29521213/advances-in-spirocyclic-hybrids-chemistry-and-medicinal-actions
#10
Mohammed Benabdallah, Oualid Talhi, Fatiha Nouali, Nourredine Choukchou-Braham, Khaldoun Bachari, Artur M S Silva
The present review deals with the progress in medicinal chemistry of spirocyclic compounds, a wider class of natural and synthetic organic molecules, defined as a hybrid of two molecular entities covalently linked via a unique tetrahedral carbon. This spiro central carbon confers to the molecules a tridimensional structurally oriented framework, which is found in many medicinally relevant compounds, a well-known example is the anti-hypertensive spironolactone. Various bioactive natural products possess the privileged spiro linkage and different chemo-types thereof become synthetically accessible since the 20th century...
March 9, 2018: Current Medicinal Chemistry
https://www.readbyqxmd.com/read/29472988/mineralocorticoid-hypertension-and-hypokalaemia-induced-by-posaconazole
#11
Charlotte Boughton, David Taylor, Lea Ghataore, Norman Taylor, Benjamin C Whitelaw
We describe severe hypokalaemia and hypertension due to a mineralocorticoid effect in a patient with myelodysplastic syndrome taking posaconazole as antifungal prophylaxis. Two distinct mechanisms due to posaconazole are identified: inhibition of 11β hydroxylase leading to the accumulation of the mineralocorticoid hormone 11-deoxycorticosterone (DOC) and secondly, inhibition of 11β hydroxysteroid dehydrogenase type 2 (11βHSD2), as demonstrated by an elevated serum cortisol-to-cortisone ratio. The effects were ameliorated by spironolactone...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29463627/spironolactone-versus-clonidine-as-a-fourth-drug-therapy-for-resistant-hypertension-the-rehot-randomized-study-resistant-hypertension-optimal-treatment
#12
Eduardo M Krieger, Luciano F Drager, Dante M A Giorgi, Alexandre C Pereira, José Augusto Soares Barreto-Filho, Armando R Nogueira, José Geraldo Mill, Paulo A Lotufo, Celso Amodeo, Marcelo C Batista, Luiz C Bodanese, Antônio C C Carvalho, Iran Castro, Hilton Chaves, Eduardo A S Costa, Gilson S Feitosa, Roberto J S Franco, Flávio D Fuchs, Armênio C Guimarães, Paulo C Jardim, Carlos A Machado, Maria E Magalhães, Décio Mion, Raimundo M Nascimento, Fernando Nobre, Antônio C Nóbrega, Antônio L P Ribeiro, Carlos R Rodrigues-Sobrinho, Antônio F Sanjuliani, Maria do Carmo B Teixeira, Jose E Krieger
The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring...
April 2018: Hypertension
https://www.readbyqxmd.com/read/29463394/interactions-cardior%C3%A3-nales
#13
P Rossignol, L Juillard
Hypertension is common in patients with chronic renal disease particularly those with diabetes. It is sometimes resistant to the pharmacological treatment. The mineralocorticoid receptor antagonist spironolactone may be indicated here. The mineralocorticoid receptor antagonists have a Class 1, Level A indication for the treatment of heart failure with reduced ejection fraction. There is an associated risk of worsening renal function and of hyperkalemia which does not hinder their clinical benefit. However, an appropriate biological monitoring is warranted, along with potential dose adaptations...
June 2017: Néphrologie & Thérapeutique
https://www.readbyqxmd.com/read/29453922/a-short-review-of-primary-aldosteronism-in-a-question-and-answer-fashion
#14
Frederick-Anthony Farrugia, Nicolaos Zavras, Georgios Martikos, Panagiotis Tzanetis, Anestis Charalampopoulos, Evangelos P Misiakos, Dimitrios Sotiropoulos, Nikolaos Koliakos
OBJECTIVES: The aim of this study was to present up to date information concerning the diagnosis and treatment of primary aldosteronism (PA). PA is the most common cause of endocrine hypertension. It has been reported up to 24% of selective referred hypertensive patients. METHODS: We did a search in Pub-Med and Google Scholar using the terms: PA, hyperaldosteronism, idiopathic adrenal hyperplasia, diagnosis of PA, mineralocorticoid receptor antagonists, adrenalectomy, and surgery...
January 1, 2018: Endocrine Regulations
https://www.readbyqxmd.com/read/29430412/study-of-drug-drug-interactions-among-the-hypertensive-patients-in-a-tertiary-care-teaching-hospital
#15
Ansha Subramanian, Mangaiarkkarasi Adhimoolam, Suresh Kannan
Aim: Drug-drug interactions (DDIs) are one of the major but preventable cause of adverse drug reaction. Study of prevalence and prediction of DDIs will make the physician easier to provide better patient care and mitigate patient's harm. Hence, the study was planned to evaluate the potential DDIs among medication prescribed to hypertensive patients in our hospital. Materials and Methods: A prospective, cross-sectional study was conducted among the hypertensive patients in medicine (outpatient/inpatient) department over the period of three months in a tertiary care hospital...
January 2018: Perspectives in Clinical Research
https://www.readbyqxmd.com/read/29375225/low-dose-spironolactone-monotherapy-in-the-management-of-stage-i-essential-hypertension-a-pilot-randomized-double-blind-placebo-controlled-trial
#16
Armin Attar, Amir-Abbas Sadeghi, Fatemeh Amirmoezi, Kamran Aghasadeghi
Background: High blood pressure (BP) is a common chronic disease needs long life drug consumption to control. Spironolactone could be used as the fourth-line therapy in patients with resistant hypertension. However, there is no study to determine the effects of low dose spironolactone as a first line therapy in treatment of essential hypertension. The aim of this study is to investigate the effect of low dose spironolactone monotherapy in management of essential hypertension. Methods: In this double blind randomized clinical trial, 40 patients who had stage I essential hypertension were randomly divided into two groups: intervention group received spironolactone 25 milligram once daily for one month and control group received placebo once daily...
January 2018: Acta Cardiologica Sinica
https://www.readbyqxmd.com/read/29316186/organ-damage-changes-in-patients-with-resistant-hypertension-randomized-to-renal-denervation-or-spironolactone-the-denervhta-denervaci%C3%A3-n-en-hipertensi%C3%A3-n-arterial-study
#17
Anna Oliveras, Pedro Armario, Laia Sans, Albert Clarà, Susana Vázquez, Luis Molina, Júlia Pareja, Alejandro de la Sierra, Julio Pascual
Renal denervation and spironolactone have both been proposed for the treatment of resistant hypertension, but their effects on preclinical target organ damage have not been compared. Twenty-four patients with 24-hour systolic blood pressure ≥140 mm Hg despite receiving three or more full-dose antihypertensive drugs, one a diuretic, were randomized to receive spironolactone or renal denervation. Changes in 24-hour blood pressure, urine albumin excretion, arterial stiffness, carotid intima-media thickness, and left ventricular mass index were evaluated at 6 months...
January 2018: Journal of Clinical Hypertension
https://www.readbyqxmd.com/read/29310346/a-systematic-review-and-meta-analysis-of-the-impact-of-mineralocorticoid-receptor-antagonists-on-glucose-homeostasis
#18
REVIEW
Sandra Korol, Fannie Mottet, Sylvie Perreault, William L Baker, Michel White, Simon de Denus
BACKGROUND: Spironolactone, a nonselective mineralocorticoid receptor antagonist (MRA), may have a deleterious effect on glycemia. The objective of this review was to assess current knowledge on MRAs' influence (spironolactone, eplerenone, and canrenone) on glucose homeostasis and the risk of diabetes. METHOD: A systematic review was conducted using the Medline database on articles published from 1946 to January 2017 that studied the effects of MRAs on any glucose-related endpoints, without any restrictions regarding the participants' characteristics...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29287767/resistant-hypertension-renal-denervation-or-intensified-medical-treatment
#19
REVIEW
Alberto Morganti, Giuseppe Mancia
Resistant hypertension (RH) can be diagnosed if blood pressure (BP) is not controlled with the combination of three antihypertensive drugs, including a diuretic, all at effective doses. Patients affected by this condition exhibit a marked increase in the risk of cardiovascular and renal morbid and fatal events. They also exhibit an increased activity of the sympathetic nervous system which is likely to importantly contribute at the renal and other vascular levels to the hypertensive state. Almost 10years ago renal denervation (RDN) by radiofrequency thermal energy delivery to the walls of the renal arteries was proposed for the treatment of RH...
December 27, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/29275380/double-hit-a-unique-case-of-resistant-hypertension
#20
Kristen Elizabeth DeCarlo, Nidhi Agrawal
A middle-aged woman with obesity, hyperlipidaemia and diet-controlled diabetes was referred for resistant hypertension. Her blood pressure (BP) was uncontrolled on five medications, including a diuretic. Physical exam revealed a systolic ejection murmur, and ECHO demonstrated moderate hypertrophy. Laboratory examination revealed elevated aldosterone level (20.7 ng/dL) and elevated aldosterone:renin ratio (41.4 (ng/dL)/(ng/mL/h)), meeting criteria for primary aldosteronism (PA), and confirmed by saline infusion testing...
December 22, 2017: BMJ Case Reports
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