Managing resistant hypertension: focus on mineralocorticoid-receptor antagonists

Figures

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  Figure 1. Relationships among factors in resistant hypertension. Notes: Increased aldosterone secretion increases activation of the SNS. Intravascular volume control is obtained by directly influencing electrolyte balance via changes in endothelial permeability and inhibition of sodium reabsorption in proximal and distal nephrons and increased SNS activity. Solid lines indicate principal pathways; dotted lines indicate secondary pathways. Data from Goodfriend and Calhoun.70 Abbreviations: SNS, sympathetic nervous system; OSAS, obstructive sleep-apnea syndrome; JG, juxtaglomerular; MS, metabolic syndrome; FAs, fatty acids.

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  Figure 2. Fourth-line antihypertensive agents in patients with RHTN. Notes: MRAs compete for the binding sites of aldosterone, effectively decrease blood pressure, and attenuate end-organ damage, mainly because of preventing nongenomic effects of aldosterone, which lead to arterial stiffness and increased oxidative stress. Abbreviations: RHTN, resistant hypertension; MRAs, mineralocorticoid-receptor agonists; RAAS, renin-angiotensin-aldosterone system; CNS, central nervous system.