title: The Effects of Aldosterone Antagonists in Patients With Resistant Hypertension: A Meta-Analysis of Randomized and Nonrandomized Studies.
abstract: BACKGROUND
  A few studies have shown aldosterone antagonists (AA) to be effective therapy in patients with resistant hypertension (RH). We performed a meta-analysis of randomized and nonrandomized studies of AA in patients with RH.
  
  
  METHODS
  We searched PUBMED, EMBASE, and CENTRAL for studies on the use of AA in patients with RH. Meta-analysis was performed using random-effects model. The change in office and ambulatory blood pressures (BP), effects on biochemical profile, change in the number of antihypertensive agents, and adverse events were main outcomes.
  
  
  RESULTS
  We included 15 studies (3 randomized controlled trials, 1 nonrandomized comparative study, and 11 single-arm studies) with 1,204 total patients in the meta-analysis. In comparative studies, AA reduced systolic BP (SBP) by 24.26 mm Hg (95% CI: 8.65-39.87, P = 0.002) and diastolic BP (DBP) by 7.79 mm Hg (3.79-11.79, P = 0.0001). Similarly, AA reduced SBP by 22.74 mm Hg (18.21-27.27, P < 0.00001) and DBP by 10.49 mm Hg (8.85-12.13, P < 0.00001) in single-arm studies. AA resulted in significant change in serum electrolytes in single-arm studies but not in comparative studies. Significantly more adverse events were noted in single-arm studies but not in comparative studies.
  
  
  CONCLUSIONS
  On the basis of the current meta-analysis, we conclude that AA is safe and effective therapy in patients with RH.
authors: Department of Medicine, LRGHealthcare, Laconia, New Hampshire, USA; kdahal@lrgh.org.
authors: Khagendra
authors: K
authors: Dahal
authors: Department of Medicine, LRGHealthcare, Laconia, New Hampshire, USA;
authors: Sumit
authors: S
authors: Kunwar
authors: Department of Medicine, Miriam Hospital, Brown University, Providence, Rhode Island, USA;
authors: Jharendra
authors: J
authors: Rijal
authors: Department of Medicine, West Virginia School of Medicine, Morgantown, West Virginia, USA;
authors: Fahad
authors: F
authors: Alqatahni
authors: Department of Medicine, LRGHealthcare, Laconia, New Hampshire, USA;
authors: Raju
authors: R
authors: Panta
authors: Division of Nephrology, LRGHealthcare, Laconia, New Hampshire, USA.
authors: Noshi
authors: N
authors: Ishak
authors: Division of Nephrology, LRGHealthcare, Laconia, New Hampshire, USA.
authors: Roy Patterson
authors: RP
authors: Russell
mesh_terms: D000959:Antihypertensive Agents / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D016903:Drug Monitoring; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D054539:Medication Therapy Management; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology*
chemical_list: D000959:Antihypertensive Agents; D000451:Mineralocorticoid Receptor Antagonists
keywords: aldosterone antagonists; blood pressure; eplerenone; hypertension; meta-analysis; resistant hypertension; spironolactone.