title: Validation of a therapeutic scheme for the treatment of resistant hypertension.
abstract: We tested the hypothesis that a therapeutic strategy of substituting the diuretic (most commonly hydrochlorothiazide) with chlorthalidone (50 mg/day), and, if needed, the calcium channel blocker with the highest dose of the most commonly used calcium antagonist (amlodipine 10 mg), and adding on top a direct renin inhibitor (aliskiren 300 mg) is effective to treat resistant hypertensive patients not responding to spironolactone. The scheme was tested in a group of 76 patients who had true treatment resistant hypertension (24-hour mean blood pressure ≥130/80 mm Hg while receiving three or more drugs). An effective response to spironolactone was defined as 24-hour ambulatory systolic blood pressure (SBP) drop by more than 20 mm Hg, and was obtained with 25-50 mg in 60 patients (78.9%). In patients with inadequate response to spironolactone (n = 16), we administered the triple combination plus the remaining therapy, a mean decrease of 29 mm Hg (95% CI 11-48; P = .004) for SBP and 12 mm Hg (95% CI: 4-20 mm Hg) for diastolic BP were observed. In only 1 of 16 patients (6%), the response was considered as insufficient. These data indicate the need for further testing this scheme that looks really promising to treat resistant hypertensive patients not responding to spironolactone.
authors.affiliation: Department of Nephrology, Hospital 12 de Octubre, Madrid, Spain. hta@juliansegura.com
authors.forename: Julian
authors.initials: J
authors.lastname: Segura
authors.forename: Cesar
authors.initials: C
authors.lastname: Cerezo
authors.forename: Jose A
authors.initials: JA
authors.lastname: Garcia-Donaire
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D017311:Amlodipine / Q000008:administration & dosage*; D002121:Calcium Channel Blockers / Q000008:administration & dosage*; D002752:Chlorthalidone / Q000008:administration & dosage*; D004232:Diuretics / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005650:Fumarates / Q000008:administration & dosage*; D005665:Furosemide / Q000008:administration & dosage*; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013148:Spironolactone / Q000008:administration & dosage; D016896:Treatment Outcome; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D017311:Amlodipine; D002121:Calcium Channel Blockers; D002752:Chlorthalidone; D004232:Diuretics; D005650:Fumarates; D005665:Furosemide; D006852:Hydrochlorothiazide; D013148:Spironolactone; D000092502:Renin Inhibitors; C446481:aliskiren