Spironolactone versus sympathetic renal denervation to treat true resistant hypertension: results from the DENERVHTA study - a randomized controlled trial.

ABSTRACT:

Objective

Both renal denervation (RDN) and spironolactone have been proposed for the treatment of resistant hypertension. However, they have not been compared in a randomized clinical trial. We aimed to compare the efficacy of spironolactone versus RDN in patients with resistant hypertension.

Methods

A total of 24 patients with office SBP at least 150?mmHg and 24-h SBP at least 140?mmHg despite receiving at least three full-dose antihypertensive drugs, one a diuretic, but without aldosterone antagonists, were randomized to receive RDN or spironolactone (50?mg) as add-on therapy. Primary endpoint was change in 24-h SBP at 6 months. Comparisons between treatment groups were performed using generalized linear models adjusted by age, sex, and baseline values.

Results

Spironolactone was more effective than RDN in reducing 24-h SBP and 24-h DBP: mean baseline-adjusted differences between the two groups were -17.9?mmHg (95%CI -30.9 to -4.9); P?=?0.010 and -6.6?mmHg (95%CI -12.9 to -0.3); P?=?0.041, for 24-h SBP and 24-h DBP, respectively. As regards changes in office blood pressure, mean baseline-adjusted differences between the two groups were -12.1?mmHg (95%CI -29.1 to 5.1); P?=?0.158 and of -5.3?mmHg (95%CI -16.3 to 5.8); P?=?0.332, for office SBP and office DBP, respectively. Otherwise, the decrease of estimated glomerular filtration rate was greater in the spironolactone group; mean baseline-adjusted difference between the two groups was -10.7?ml/min per 1.73 m (95%CI -20.1 to -1.4); P?=?0.027.

Conclusion

We conclude that spironolactone is more effective than RDN to reduce 24-h SBP and 24-h DBP in patients with resistant hypertension. Therefore, spironolactone should be the fourth antihypertensive drug to prescribe if deemed well tolerated' in all patients with resistant hypertension before considering RDN.

SUBMITTER: Oliveras A 

PROVIDER: S-EPMC4972478 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature