For patients with resistant hypertension, adding spironolactone was significantly more effective than adding other antihypertensives, researchers presented at the European Society of Cardiology Congress 2015.

The PATHWAY-2 study assessed whether additional therapy with spironolactone would be most effective at lowering blood pressure compared to treatment with two other antihypertensives with different mechanisms of action: doxazosin and bisoprolol. The study enrolled patients with resistant hypertension (defined as uncontrolled blood pressure despite treatment with ≥3 antihypertensives) who were already treated with maximally tolerated doses of an ACE inhibitor/ARB; a calcium channel blocker (CCB); and a thiazide-type diuretic. Uncontrolled blood pressure was defined as a seated clinic systolic blood pressure of ≥140mmHg for non-diabetic patients or ≥135mmHg for patients with diabetes, and a home systolic blood pressure (HSBP) of 130mmHg for all patients. Patients were randomized to receive 12 weeks of spironolactone, bisoprolol, doxazosin and placebo in random order, in addition to their standard blood pressure therapy. The study’s primary endpoint was HSBP for each treatment; clinic systolic blood pressure was a secondary point.

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Spironolactone showed superior HSBP control vs. placebo in 314 patients (reduction of 8.7mmHg; P<0.001); doxazosin (reduction of 4.03mmHg; P<0.001); and bisoprolol (reduction of 4.48mmHg; P<0.001). Almost 75% of patients with uncontrolled blood pressure experienced an improvement in their blood pressure with spironolactone, with almost 60% achieving stringent measure of control (P<0.001).

Study authors concluded spironolactone was best at reducing blood pressure in 60% compared to bisoprolol and doxazosin being the best in 17% and 18%, respectively. These findings suggest that treatments with natriuretic action are likely to be the most effective in treating resistant hypertension.

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