Abstract P624: Prevalence, Predictors and Comparison of Spironolactone versus Clonidine as a Fourth Drug for Resistant Hypertension: the Resistant Hypertension Optimal Treatment (ReHOT) study

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Eduardo M Krieger ◽  
Luciano F Drager ◽  
Dante M Giorgi ◽  
Alexandre C Pereira ◽  
José A Barreto-Filho ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Endpoint ◽  
Resistant Hypertension ◽  
Blood Pressure Monitoring ◽  
Controlled Trial ◽  
Blood Pressure Reduction ◽  
National Research Council ◽  
Study Entry ◽  
Hypertension Optimal Treatment ◽  
Admixed Population

Background: The prevalence, predictors and the best anti-hypertensive regimen for resistant hypertension (RH) are not well established especially in Countries with multiethnic profile. Our main aim was to compare spironolactone versus clonidine as a fourth drug therapy for patients with RH. Methods: This is a multicentric, randomized controlled trial comprising 26 sites in Brazil that recruited outpatients from a highly admixed population with hypertension stage 2 (≥160/100mmHg) at study entry. Medical therapy adherence was checked by pill counting. Patients with confirmed RH (no office and 24hs ambulatory blood pressure monitoring - ABPM - control despite treatment with 3 drugs including a diuretic for 12 weeks) were randomized to additional 12 weeks treatment with spironolactone (12.5-50mg once daily) or clonidine (0.1-0.3mg twice daily). The primary endpoint was blood pressure (BP) control from both office (<140/90mmHg) and 24hs ABPM (<130/80mmHg). Secondary endpoints included absolute and relative BP reductions in each study arm. Results: A total of 1597 patients were included in the analysis. We found that 14.9% (238 patients) fulfilled the RH criteria. Predictors of true RH include male gender (OR 1.43; CI 1.02-2.00), previous stroke (OR 2.81; CI 1.51-5.06), diabetes (OR 2.09; CI 1.48-2.94) and BP ≥180x110mmHg at study entry (OR 2.53; CI 1.88-3.43). Compared to patients randomized to spironolactone (n=119), those patients randomized to clonidine (n=119) presented similar rate of the primary endpoint (19.8 vs. 24%, respectively; p=0.59). Similarly, no differences were observed between groups in the blood pressure reduction analyzed either by office as well as by 24-h ABPM. No differences in the pill counting monitoring were observed in the groups. Conclusions: Appropriate treatment for stage 2 hypertension under the national universal health care conditions provided blood pressure control in 85% from a highly admixed population. Spironolactone or clonidine displayed comparable BP control as a fourth drug in patients with RH. Funding: Ministry of Health/H. Samaritano, National Research Council, Sao Paulo Research Foundation and Zerbini Foundation.

scholarly journals Renal Denervation After Symplicity HTN-3 – Back to Basics. Review of the Evidence

2014 ◽  
Vol 9 (2) ◽  
pp. 110 ◽  
Author(s):  
Alexandre Persu ◽  
Fadl Elmula M Fadl Elmula ◽  
Yu Jin ◽  
Ingrid Os ◽  
Sverre E Kjeldsen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Controlled Trial ◽  
Blood Pressure Reduction ◽  
Renal Sympathetic Denervation ◽  
Drug Adherence ◽  
Regression To The Mean ◽  
Blood Pressure Lowering Effect ◽  
Blood Pressure Elevation

Renal sympathetic denervation (RDN) has been proposed as a new treatment modality in patients with apparent treatment resistant hypertension, a condition defined as office blood pressure elevation despite prescription of at least three antihypertensive drugs including a diuretic. However, the impressive fall in blood pressure reported after RDN in Symplicity HTN-2, the first randomised study, and multiple observational studies has not been confirmed in the US sham-controlled trial Symplicity HTN-3 and four subsequent prospective randomised studies, all published or presented in 2014. The blood pressure reduction documented in earlier studies may be largely due to non-specific effects such as improvement of drug adherence in initially poorly adherent patients (Hawthorne effect), placebo effect and regression to the mean. The overall blood pressure lowering effect of RDN seems rather limited and the characteristics of true responders remain largely unknown. Accordingly, RDN is not ready for clinical practice. In most patients with apparent drug-resistant hypertension, drug monitoring and subsequent improvement of drug adherence may prove more effective and cost-beneficial to achieve blood pressure control. In the meantime, research should aim at identifying characteristics of those few patients adherent to drug treatment and with true resistant hypertension who may respond to RDN.

scholarly journals Prognostic Value of Nocturnal Blood Pressure Reduction in Resistant Hypertension

2009 ◽  
Vol 169 (9) ◽  
pp. 874 ◽  
Author(s):  
Elizabeth Silaid Muxfeldt ◽  
Claudia Regina Lopes Cardoso ◽  
Gil Fernando Salles
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Prognostic Value ◽  
Blood Pressure Reduction ◽  
Pressure Reduction ◽  
Nocturnal Blood Pressure

scholarly journals 0772 Effects Of Solriamfetol On 24-hour Blood Pressure Patterns In Participants With Excessive Daytime Sleepiness Associated With Narcolepsy

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A293-A293
Author(s):  
P J Strollo ◽  
A Malhotra ◽  
K Strohl ◽  
J Pepin ◽  
P Schweitzer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Excessive Daytime Sleepiness ◽  
Daytime Sleepiness ◽  
Time Course ◽  
Blood Pressure Monitoring ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Obstructive Sleep ◽  
Norepinephrine Reuptake Inhibitor ◽  
Blood Pressure Patterns

Abstract Introduction Solriamfetol is a dopamine and norepinephrine reuptake inhibitor indicated to improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy (75-150 mg/d) or obstructive sleep apnea (37.5-150 mg/d). Previous studies reported small mean increases in blood pressure (BP); however, the time course of these effects has not been evaluated. In addition, effects on BP dipping, which has been shown to be a risk factor for adverse cardiovascular outcomes, have not been evaluated. These analyses evaluated the effects of solriamfetol treatment on BP using 24-hour ambulatory blood pressure monitoring (ABPM) and on the percentage of narcolepsy patients with a non-dipping BP profile. Methods Twenty-four-hour ABPM was conducted at baseline and week 8 in a 12-week randomized controlled trial in participants with narcolepsy (n=236). Results At week 8, increases in BP were apparent in the 150 and 300 mg dose groups from 8 AM until 4 PM and 6 PM, respectively. At baseline, 52% (placebo) and 48% (combined solriamfetol) of participants were non-dippers (defined as &lt;10% decrease in mean arterial pressure [MAP] during sleep). There was no increase in the percentage of non-dippers at week 8 relative to baseline (placebo, 44%; combined solriamfetol, 39%). Results were similar when dipping was defined by changes in systolic BP and diastolic BP. Conclusion The effects of solriamfetol on BP at the highest approved dose of 150 mg/d are transient across the day. Solriamfetol was not observed to have an increase in non-dipping classification in participants with narcolepsy at any dose studied. Support Jazz Pharmaceuticals

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