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Effect of aldosterone antagonists on blood pressure in patients with resistant hypertension: a meta-analysis

Journal of Human Hypertension volume 29, pages 159–166 (2015)Cite this article

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Abstract

There is currently limited data on which drug should be used to improve blood pressure (BP) control in patients with resistant hypertension (RH). We performed a systematic review and meta-analysis of published studies evaluating the anti-hypertensive benefit of aldosterone antagonists (AA) as an add-on therapy in patients with RH. A systematic literature search for eligible studies was conducted until June 2014, using literature databases and hand search. Studies were stratified according to controlled vs uncontrolled design and analyzed using random-effect models. We identified 13 eligible studies involving a total of 2640 patients, consisting of 3 randomized controlled trials, and 10 observational studies without a control group. In controlled studies, there was a reduction in mean systolic and diastolic BP of −16.5 (95% confidence interval (CI), −30.0 to −3.0) and −4.1 (95% CI, −7.8 to −0.32) mm Hg, respectively, compared with control. In uncontrolled studies, there was a reduction in mean systolic and diastolic BP of −19.7 (95% CI, −23.2 to −16.2) and −9.1 (95% CI, −10.3 to −7.8) mm Hg, respectively, compared with pre-AA therapy. Subgroup analysis showed that the systolic BP change was more pronounced in patients with baseline systolic BP >150 mm Hg (weighted mean difference (WMD), −23.1 mm Hg) than in patients with ⩽150 mm Hg (WMD, −15.4 mm Hg) (between groups P<0.001), suggesting that the baseline systolic BP was a predictor of the BP response to AA treatment. Furthermore, AA demonstrated a mild increase in serum potassium and creatinine (for both, P<0.001). The findings suggest that AA as an add-on therapy was effective for lowering systolic and diastolic BP in patients with RH.

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Acknowledgements

The present study was supported by a grant from the Beijing Science and Technique Programs of China (Z131100006813039).

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Authors and Affiliations

  1. Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People’s Republic of China

    G Liu, X-X Zheng, Y-L Xu, J Lu, R-T Hui & X-H Huang

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Correspondence to X-H Huang.

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Liu, G., Zheng, XX., Xu, YL. et al. Effect of aldosterone antagonists on blood pressure in patients with resistant hypertension: a meta-analysis. J Hum Hypertens 29, 159–166 (2015). https://doi.org/10.1038/jhh.2014.64

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