title: New Evidence Supporting the Use of Mineralocorticoid Receptor Blockers in Drug-Resistant Hypertension.
abstract: Treatment resistant hypertension (TRH), defined as a blood pressure above goal despite treatment with optimally tolerated doses of 3 antihypertensive agents of different classes, ideally including a diuretic, remains a significant problem and its management an area of uncertainty for physicians. One hypothesis is that resistant hypertension is due to abnormal sodium retention, mediated by aldosterone breakthrough occurring despite blockade of the renin-angiotensin-aldosterone system with angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB). Thus, there has been renewed interest in the use of mineralocorticoid receptor blockers (MRB) to treat this condition. This article critically evaluates new evidence supporting the use of MRB in TRH published in the last 3 years. We conclude that there is now sufficient evidence to recommend MRB, in particular spironolactone, as the first choice medication to treat this condition, and for its inclusion in future guidelines.
authors.affiliation: Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK. hafid.narayan@nhslothian.scot.nhs.uk.
authors.forename: Hafid
authors.initials: H
authors.lastname: Narayan
authors.affiliation: The Queen's Medical Research Institute, University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Webb
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D015201:Meta-Analysis as Topic; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D018161:Receptors, Mineralocorticoid / Q000378:metabolism*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D018161:Receptors, Mineralocorticoid
keywords: Eplerenone; Mineralocorticoid receptor blockers; Resistant hypertension; Spironolactone