title: Should All Patients with Resistant Hypertension Receive Spironolactone?
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  A range of randomized and non-randomized studies have proved the efficacy of mineralocorticoid receptor antagonists, including spironolactone. However, long-term mortality studies are still missing for the hypertensive population. In the case of spironolactone side effects, higher doses of amiloride or eplerenone might be used. Based on available data and our own experience, spironolactone (mineralocorticoid receptor antagonists) should be involved, if tolerated, in combination therapy in true resistant hypertensive patients. Spironolactone still represents primary therapeutic modality under specific conditions of primary aldosteronism.
authors: 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic. jan.rosa@lf1.cuni.cz.|Cardiocenter, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic. jan.rosa@lf1.cuni.cz.
authors: Ján
authors: J
authors: Rosa
authors: 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors: Tomáš
authors: T
authors: Zelinka
authors: 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors: Ondřej
authors: O
authors: Petrák
authors: 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors: Branislav
authors: B
authors: Štrauch
authors: 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors: Robert
authors: R
authors: Holaj
authors: 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.
authors: Jiří
authors: J
authors: Widimský
mesh_terms: D004232:Diuretics / Q000627:therapeutic use*; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D013148:Spironolactone / Q000627:therapeutic use*
chemical_list: D004232:Diuretics; D013148:Spironolactone
keywords: Mineralocorticoid receptor antagonists; Resistant hypertension; Spironolactone