Journal
JOURNAL OF CLINICAL HYPERTENSION
Volume 11, Issue 5, Pages 245-252Publisher
WILEY
DOI: 10.1111/j.1751-7176.2009.00110.x
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Funding
- CAPES (Coordenacao de Aperfeic,oamentode Pessoal de Nivel Superior)
- CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnologia)
- FAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo), Brazil
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Aldosterone excess or escape can occur after treatment with medications that block the renin-angiotensin-aldosterone system or in undiagnosed primary aldosteronism. Spironolactone is thought to be an important addition to resistant hypertension (RH) treatment. In this study, resistant (RH) and controlled (CH) hypertensives and normotensive patients were submitted to echocardiography, flow-mediated vasodilation, carotid intima-media wall thickness studies, renin plasma activity, and aldosterone plasma levels and plasma and urinary sodium and potassium concentrations at baseline (pre-spironolactone phase). Subsequently, for only RH and CH groups, 25 mg/d spironolactone was added to preexisting treatments over 6 months. Afterwards, these parameters were reassessed (post-spironolactone phase). The RH and CH groups achieved reductions in blood pressure (P <.001), decreases in left ventricular hypertrophy (P <.001), improved diastolic function (Kappa index RH: 0.219 and Kappa index CH: 0.392) and increases in aldosterone concentrations (P <.05). The RH group attained improved endothelium-dependent (P <.001) and independent (P=.007) function. Optimized RH treatment with spironolactone reduces blood pressure and improves endothelial and diastolic function and left ventricular hypertrophy despite the presence of aldosterone excess or escape.
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