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)

Figures

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  Figure 1. Study design. Process of randomization and follow-up of the patients. t0, Weeks −4 to 0. All patients maintained treatment with losartan (100–200 mg), chlorthalidone (25 mg), and amlodipine (5 mg). t1, Weeks 0–4. Individuals with BP levels ≥ 140/90 mmHg on office measurements and ≥ 130/80 mmHg on 24-hour ABPM were randomized to one of the study groups. Participants received spironolactone 25 mg (SNB group) or ramipril 5 mg (DRASB group). t2, Weeks 4–8. Participants with office BP <140/90 mmHg continued the same regimen, while those with office BP ≥140/90 mmHg received, in addition to the existing regimen, furosemide 20 mg (SNB group) or ramipril 10 mg (DRASB group). t3, Weeks 8–12. Participants with office BP <140/90 mmHg continued on the same regimen, while those with office BP ≥140/90 mmHg received furosemide 40 mg (SNB group) or bisoprolol 5 mg (DRASB group). t4, Weeks 12–16. Participants with office BP <140/90 mmHg continued on the same regimen, while those with office BP ≥ 140/90 mmHg received additional amiloride 5 mg (SNB group) or bisoprolol 10 mg (DRASB group). t5, Weeks 16–20. Blood samples were drawn from all patients, and office BP and ABPM were performed.

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  Figure 2. Flowchart of study.

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  Figure 3. Percentage of patients with resistant hypertension controlled by dual renin-angiotensin blockade + bisoprolol and sequential nephron blockade as determined by ambulatory blood pressure monitoring and office measurements after 20 weeks of treatment.