1
|
Sun R, Li Y, Lv L, Zhang W, Guo X. Efficacy and safety of esaxerenone (CS-3150) in primary hypertension: a meta-analysis. J Hum Hypertens 2024; 38:102-109. [PMID: 38177694 PMCID: PMC10844087 DOI: 10.1038/s41371-023-00889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
This study aimed to assess the efficacy and safety of esaxerenone (CS-3150) in treating primary hypertension. PubMed (Medline), Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases were searched for articles published until April 18, 2023. The outcomes included were diastolic blood pressure (DBP), systolic blood pressure (SBP), 24 h DBP, 24 h SBP, and adverse events. The meta-analysis was conducted using RevMan 5.3. This study included three trials. CS-3150 5 mg had a greater effect on lowering the SBP, DBP, 24 h SBP, and 24 h DBP than either CS-3150 2.5 mg or eplerenone 50 mg. In contrast, CS-3150 2.5 mg and eplerenone 50 mg showed no significant difference in lowering DBP, SBP, 24 h DBP, and 24 h SBP. Moreover, adverse events occurred at comparable rates in the three groups. CS-3150 (especially CS-3150 5 mg) is an effective and safe treatment for primary hypertension; which can reduce blood pressure and alleviate hypertensive symptoms.
Collapse
Affiliation(s)
- Ran Sun
- Department of Metabolism, Shanxi Institute of Traditional Chinese Medicine, Taiyuan, 030000, China
| | - Yali Li
- Department of Metabolism, Shanxi Institute of Traditional Chinese Medicine, Taiyuan, 030000, China
| | - Lei Lv
- Department of Metabolism, Shanxi Institute of Traditional Chinese Medicine, Taiyuan, 030000, China
| | - Weiliang Zhang
- Department of Metabolism, Shanxi Institute of Traditional Chinese Medicine, Taiyuan, 030000, China
| | - Xiaoxia Guo
- Department of Metabolism, Shanxi Institute of Traditional Chinese Medicine, Taiyuan, 030000, China.
| |
Collapse
|
2
|
Cestario EDES, Vilela-Martin JF, Cosenso-Martin LN, Rubio TA, Uyemura JRR, da Silva Lopes V, Fernandes LAB, Bonalume Tacito LH, Moreno Junior H, Yugar-Toledo JC. Effect of Sequential Nephron Blockade versus Dual Renin-Angiotensin System Blockade Plus Bisoprolol in the Treatment of Resistant Hypertension, a Randomized Controlled Trial (Resistant Hypertension on Treatment - ResHypOT). Vasc Health Risk Manag 2022; 18:867-878. [PMID: 36545494 PMCID: PMC9762262 DOI: 10.2147/vhrm.s383007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Hypertension is the most important modifiable risk factor for cardiovascular disease and a leading public health concern. Objectives The primary aim was to compare sequential nephron blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment. Material and Methods This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug up-titration. Participants were evaluated during five visits at 28-day intervals. Results The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5±21.0 to 127.0±14.74 mmHg (p<0.0001), and DBP decreased from 105.3±15.5 to 78.11±9.28 mmHg (p<0.0001). DRASB group, SBP decreased from 178.4±21.08 to 134.4 ± 23.25 mmHg (p<0.0001) and DBP decreased from 102.7±11.07 to 77.33±13.75 mmHg (p<0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p<0.0001). Conclusion In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction.
Collapse
Affiliation(s)
| | - Jose Fernando Vilela-Martin
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil,Correspondence: Jose Fernando Vilela-Martin, Ave Brig Faria Lima 5416, Sao Jose do Rio Preto, São Paulo, SP, 15090-000, Brazil, Tel +55 17 32015727, Email
| | - Luciana Neves Cosenso-Martin
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
| | - Tatiane Azevedo Rubio
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
| | | | - Valquiria da Silva Lopes
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
| | | | - Lucia Helena Bonalume Tacito
- Endocrinology Division, Internal Medicine Department, Medical School in São José Rio Preto (FAMERP), São Paulo, Brazil
| | - Heitor Moreno Junior
- Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
| |
Collapse
|
3
|
Milošević M, Otašević P. Treatment-resistant hypertension. Arhiv za farmaciju 2022. [DOI: 10.5937/arhfarm72-34248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Treatment-resistant hypertension is one of the most significant causes of poor blood pressure regulation. Patients with resistant hypertension are at a higher risk of developing comorbidities compared to the general hypertensive population. As a result, these patients have an increased incidence of disability and premature death, as well as increased treatment costs. Due to the above-mentioned, in the last decade, there has been an increase in researchers' interest in elucidating the pathogenesis, diagnosis, and treatment of resistant hypertension. However, recent data indicate that 20% of female and 24% of male patients with arterial hypertension still have uncontrolled blood pressure, despite maximum doses of three antihypertensive drugs (including a diuretic) and appropriate lifestyle measures. New treatment modalities (i.e. devicebased interventions - catheter-based renal denervation and baroreceptor stimulation) offer hope for achieving adequate blood pressure regulation in these patients. In this paper, we have summarized previous knowledge about the mechanisms underlying the pathogenesis of resistant hypertension, as well as optimal diagnostic methods to differentiate true from pseudo-resistant hypertension. We have also given an overview of the current therapeutic approach, including optimal medical therapy and new treatment modalities (i.e. device-based interventions) and their role in the treatment of resistant hypertension.
Collapse
|
4
|
Feyz L, van den Berg S, Zietse R, Kardys I, Versmissen J, Daemen J. Effect of renal denervation on catecholamines and the renin-angiotensin-aldosterone system. J Renin Angiotensin Aldosterone Syst 2021; 21:1470320320943095. [PMID: 32862760 PMCID: PMC7457701 DOI: 10.1177/1470320320943095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: The effect of renal sympathetic denervation (RDN) on neurohormonal responses
is largely unknown. We aimed to assess the effect of RDN on the
renin–angiotensin–aldosterone system (RAAS) and endogenous
catecholamines. Methods: A total of 60 patients with hypertension underwent RDN and remained on a
stable antihypertensive drug regimen. Samples for plasma aldosterone, plasma
renin and urine (nor)metanephrine were collected at baseline and at 6 months
post procedure. Ambulatory blood pressure (BP) recordings were obtained at
baseline and at 6 months post procedure. Results: Mean age was 64±9 years, and 30/60 patients were male. At 6 months, average
daytime systolic and diastolic ambulatory BP decreased by 10 and 6 mmHg,
respectively (p<0.001). No significant change was
observed in plasma aldosterone (median=248.0 pmol/L (interquartile range
(IQR) 113.3–369.5 pmol/L) vs. median=233.0 pmol/L (IQR 110.3–360.8 pmol/L);
p=0.66); renin (median=19.5 µIU/mL (IQR 6.8–119.5
µIU/mL) vs. median=14.3 µIU/mL (IQR 7.2–58.0 µIU/mL);
p=0.32), urine metanephrine (median=0.46 µmol/L (IQR
0.24–0.77 µmol/L) vs. median=0.46 µmol/L (IQR 0.22–0.88 µmol/L);
p=0.75) and normetanephrine (median=1.41 µmol/L (IQR
0.93–2.00 µmol/L vs. median =1.56 (IQR 0.74–2.50 µmol/L);
p=0.58) between baseline and 6 months, respectively. No
correlation was found between the decrease in mean systolic daytime BP and
changes in RAAS hormones or endogenous catecholamines. Conclusion: Despite significant reductions in ambulatory BP, RDN did not result in a
significant change in endogenous catecholamines or in RAAS hormones at 6
months.
Collapse
Affiliation(s)
- Lida Feyz
- Department of Cardiology, Erasmus MC, University Medical Centre, The Netherlands
| | - Sjoerd van den Berg
- Department of Clinical Chemistry, Erasmus MC, University Medical Centre, The Netherlands
| | - Robert Zietse
- Department of Internal Medicine, Erasmus MC, University Medical Centre, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Centre, The Netherlands
| | - Jorie Versmissen
- Department of Internal Medicine, Erasmus MC, University Medical Centre, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus MC, University Medical Centre, The Netherlands
| |
Collapse
|
5
|
Pereira SS, Carvalho L, Costa MM, Melo A, Ferreira IMPLVO, Gomez-Sanchez CE, Monteiro MP, Vinson G, Pignatelli D. Mineralocorticoid Receptor Antagonists Eplerenone and Spironolactone Modify Adrenal Cortex Morphology and Physiology. Biomedicines 2021; 9:441. [PMID: 33924172 DOI: 10.3390/biomedicines9040441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 11/16/2022] Open
Abstract
Mineralocorticoid receptor antagonists (MRAs) are a class of anti-hypertensive drugs that act by blocking aldosterone action. The aim of this study was to evaluate whether the MRAs spironolactone and eplerenone influence adrenal cortical physiology and morphology. Spontaneous hypertensive rats (SHR, n = 18) and normotensive rats (WKY, n = 18) were randomly exposed to a daily dose of spironolactone (n = 6), eplerenone (n = 6), or no drug (n = 6) over 28 days. After that, aldosterone, corticosterone, and 11-deoxycorticosterone plasma concentrations were quantified. Adrenal glands were subjected to morphological analysis to assess lipid droplets content, capsular width, cell proliferation, and steroidogenic proteins expression. The adrenal cortex in untreated SHR showed higher lipid droplet content as than in WKY. In SHR, MRA treatment was associated with higher circulating aldosterone levels and Ki-67 expression in aldosterone-secreting cells. In WKY, the only difference observed after MRA spironolactone treatment was a narrower capsule. There was no difference in abundance of steroidogenic enzyme between groups. In conclusion, MRAs modify adrenal gland function and morphology in SHR. The effects observed within the adrenal glomerulosa with aldosterone-secreting cell proliferation and higher circulating aldosterone levels suggests that MRA treatment provokes activation of the renin angiotensin system. The prognostic value of hyperaldosteronism secondary to MRAs blockade requires further investigation.
Collapse
|
6
|
Dong Y, Yan S, Li GY, Wang MN, Leng L, Li Q. Identification of key candidate genes and pathways revealing the protective effect of liraglutide on diabetic cardiac muscle by integrated bioinformatics analysis. Ann Transl Med 2020; 8:181. [PMID: 32309328 PMCID: PMC7154457 DOI: 10.21037/atm.2020.01.94] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Diabetes mellitus is becoming a significant health problem with the International Diabetes Federation (IDF) expecting a startling 642 million diabetes patients by 2040. Liraglutide, a glucagon-like peptide-1 (GLP-1) analog, is reported to protect against diabetic cardiomyopathy by binding to the receptor, GLP-1R. However, the underlying mechanism has yet to be clarified. This study aimed to investigate the underlying mechanisms and the effects of liraglutide on diabetic patient's cardiac muscles. Methods GSE102194 genetic expression profiles were extracted from the Gene Expression Omnibus (GEO) database. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway (KEGG) enrichment analyses were carried out. Next, Cytoscape software was used to construct the protein-protein interaction (PPI) network of the differentially expressed genes (DEGs). DEGs were mapped onto a protein-protein interaction (PPI) network that comprised 249 nodes and 776 edges. Results A total of 520 DEGs were discovered, including 159 down-regulated genes and 361 up-regulated genes. DEGs that were upregulated were notably enriched in biological processes (BP) such as muscle system process, muscle system process, muscle structure development and anatomical structure morphogenesis while DEGs that were downregulated were rich in detection of chemical stimulus and neurological system process. KEGG pathway analysis showed the up-regulated DEGs were enriched in adrenergic signaling for cardiomyocytes, dopaminergic synapse, and circadian entrainment, while the down-regulated DEGs were enriched for factory transduction in 249 of the 520 tested samples. The modular analysis identified 4 modules that participated in some pathways associated with cardiac muscle contraction, hypertrophic cardiomyopathy (HCM), and MAPK signaling pathway. Conclusions Our data showed that Glp-1 could decrease the protein expression of p38, JNK, ERK1/2, and MARS proteins induced by high glucose (22 mM, 72 h). This study highlights the potential physiological processes that take place in diabetic cardiac muscles exposed to liraglutide. Our findings elucidated the regulatory network in diabetic cardiomyopathy and might provide a novel diagnostic and therapeutic target for diabetic cardiomyopathy.
Collapse
Affiliation(s)
- Ying Dong
- Department of Endocrinology and Metabolic Disease, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Shi Yan
- The Fourth Medical Ward, The Tumor Hospital of Harbin Medical University, Harbin 150081, China
| | - Guo-Yan Li
- Department of Endocrinology and Metabolic Disease, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Min-Nan Wang
- Department of Endocrinology and Metabolic Disease, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Lei Leng
- Department of Endocrinology and Metabolic Disease, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Qiang Li
- Department of Endocrinology and Metabolic Disease, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| |
Collapse
|
7
|
Azzam O, Kiuchi MG, Ho JK, Matthews VB, Gavidia LML, Nolde JM, Carnagarin R, Schlaich MP. New Molecules for Treating Resistant Hypertension: a Clinical Perspective. Curr Hypertens Rep 2019; 21:80. [PMID: 31506798 DOI: 10.1007/s11906-019-0978-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW To review the findings of trials evaluating pharmacological treatment approaches for hypertension in general, and resistant hypertension (RH) in particular, and propose future research and clinical directions. RECENT FINDINGS RH is defined as blood pressure (BP) that remains above target levels despite adherence to at least three antihypertensive medications, including a diuretic. Thus far, clinical trials of pharmacological approaches in RH have focused on older molecules, with spironolactone being demonstrated as the most efficacious fourth-line agent. However, the use of spironolactone in clinical practice is hampered by its side effect profile and the risk of hyperkalaemia in important RH subgroups, such as patients with moderate-severe chronic kidney disease (CKD). Clinical trials of new molecules targeting both well-established and more recently elucidated pathophysiologic mechanisms of hypertension offer a multitude of potential treatment avenues that warrant further evaluation in the context of RH. These include selective mineralocorticoid receptor antagonists (MRAs), aldosterone synthase inhibitors (ASIs), activators of the counterregulatory renin-angiotensin-system (RAS), vaccines, neprilysin inhibitors alone and in combined formulations, natriuretic peptide receptor agonists A (NPRA-A) agonists, vasoactive intestinal peptide (VIP) agonists, centrally acting aminopeptidase A (APA|) inhibitors, antimicrobial suppression of central sympathetic outflow (minocycline), dopamine β-hydroxylase (DβH) inhibitors and Na+/H+ Exchanger 3 (NHE3) inhibitors. There is a paucity of data from trials evaluating newer molecules for the treatment of RH. Emergent novel molecules for non-resistant forms of hypertension heighten the prospects of identifying new, effective and well-tolerated pharmacological approaches to RH. There is a glaring need to undertake RH-focused trials evaluating their efficacy and clinical applicability.
Collapse
Affiliation(s)
- Omar Azzam
- Department of Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit / Medical Research Foundation, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Marcio G Kiuchi
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit / Medical Research Foundation, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Jan K Ho
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit / Medical Research Foundation, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit / Medical Research Foundation, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Leslie Marisol Lugo Gavidia
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit / Medical Research Foundation, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Janis M Nolde
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit / Medical Research Foundation, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit / Medical Research Foundation, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit / Medical Research Foundation, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia. .,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia. .,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
| |
Collapse
|
8
|
Moss ME, Carvajal B, Jaffe IZ. The endothelial mineralocorticoid receptor: Contributions to sex differences in cardiovascular disease. Pharmacol Ther 2019; 203:107387. [PMID: 31271793 DOI: 10.1016/j.pharmthera.2019.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
Abstract
Cardiovascular disease remains the leading cause of death for both men and women. The observation that premenopausal women are protected from cardiovascular disease relative to age-matched men, and that this protection is lost with menopause, has led to extensive study of the role of sex steroid hormones in the pathogenesis of cardiovascular disease. However, the molecular basis for sex differences in cardiovascular disease is still not fully understood, limiting the ability to tailor therapies to male and female patients. Therefore, there is a growing need to investigate molecular pathways outside of traditional sex hormone signaling to fully understand sex differences in cardiovascular disease. Emerging evidence points to the mineralocorticoid receptor (MR), a steroid hormone receptor activated by the adrenal hormone aldosterone, as one such mediator of cardiovascular disease risk, potentially serving as a sex-dependent link between cardiovascular risk factors and disease. Enhanced activation of the MR by aldosterone is associated with increased risk of cardiovascular disease. Emerging evidence implicates the MR specifically within the endothelial cells lining the blood vessels in mediating some of the sex differences observed in cardiovascular pathology. This review summarizes the available clinical and preclinical literature concerning the role of the MR in the pathophysiology of endothelial dysfunction, hypertension, atherosclerosis, and heart failure, with a special emphasis on sex differences in the role of endothelial-specific MR in these pathologies. The available data regarding the molecular mechanisms by which endothelial-specific MR may contribute to sex differences in cardiovascular disease is also summarized. A paradigm emerges from synthesis of the literature in which endothelial-specific MR regulates vascular function in a sex-dependent manner in response to cardiovascular risk factors to contribute to disease. Limitations in this field include the relative paucity of women in clinical trials and, until recently, the nearly exclusive use of male animals in preclinical investigations. Enhanced understanding of the sex-specific roles of endothelial MR could lead to novel mechanistic insights underlying sex differences in cardiovascular disease incidence and outcomes and could identify additional therapeutic targets to effectively treat cardiovascular disease in men and women.
Collapse
|
9
|
Manolis AA, Manolis TA, Melita H, Manolis AS. Eplerenone Versus Spironolactone in Resistant Hypertension: an Efficacy and/or Cost or Just a Men’s Issue? Curr Hypertens Rep 2019; 21. [DOI: 10.1007/s11906-019-0924-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Muxfeldt ES, Chedier B, Rodrigues CIS. Resistant and refractory hypertension: two sides of the same disease? ACTA ACUST UNITED AC 2018; 41:266-274. [PMID: 30525180 PMCID: PMC6699444 DOI: 10.1590/2175-8239-jbn-2018-0108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/05/2018] [Indexed: 01/16/2023]
Abstract
Refractory hypertension (RfH) is an extreme phenotype of resistant hypertension
(RH), being considered an uncontrolled blood pressure besides the use of 5 or
more antihypertensive medications, including a long-acting thiazide diuretic and
a mineralocorticoid antagonist. RH is common, with 10-20% of the general
hypertensives, and its associated with renin angiotensin aldosterone system
hyperactivity and excess fluid retention. RfH comprises 5-8% of the RH and seems
to be influenced by increased sympathetic activity. RH patients are older and
more obese than general hypertensives. It is strongly associated with diabetes,
obstructive sleep apnea, and hyperaldosteronism status. RfH is more frequent in
women, younger patients and Afro-americans compared to RFs. Both are associated
with increased albuminuria, left ventricular hypertrophy, chronic kidney
diseases, stroke, and cardiovascular diseases. The magnitude of the white-coat
effect seems to be higher among RH patients. Intensification of diuretic therapy
is indicated in RH, while in RfH, therapy failure imposes new treatment
alternatives such as the use of sympatholytic therapies. In conclusion, both RH
and RfH constitute challenges in clinical practice and should be addressed as
distinct clinical entities by trained professionals who are capable to identify
comorbidities and provide specific, diversified, and individualized
treatment.
Collapse
Affiliation(s)
- Elizabeth Silaid Muxfeldt
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-Graduação em Clínica Médica, Rio de Janeiro, RJ, Brasil.,Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Bernardo Chedier
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-Graduação em Clínica Médica, Rio de Janeiro, RJ, Brasil.,Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Cibele Isaac Saad Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Departamento de Medicina, Sorocaba, SP, Brasil
| |
Collapse
|