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: Khagendra Dahal, Sumit Kunwar, Jharendra Rijal, Fahad Alqatahni, Raju Panta, Noshi Ishak, Roy Patterson Russell
• Journal: American journal of hypertension (Am J Hypertens) Vol. 28 Issue 11 Pg. 1376-85 (Nov 2015) ISSN: 1941-7225 [Electronic] United States
• PMID: 25801902 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: [email protected].

Chemical References

• Antihypertensive Agents
• Mineralocorticoid Receptor Antagonists

Topics

• Antihypertensive Agents (pharmacology)
• Blood Pressure (drug effects)
• Blood Pressure Monitoring, Ambulatory (methods)
• Drug Monitoring
• Drug Resistance
• Humans
• Hypertension (blood, diagnosis, drug therapy, physiopathology)
• Medication Therapy Management
• Mineralocorticoid Receptor Antagonists (pharmacology)