Sequential nephron blockade versus sequential renin–angiotensin system blockade in resistant hypertension

167 patients with resistant hypertension (mean baseline daytime ambulatory blood pressure ≥135/85 mmHg despite 4 weeks' treatment with irbesartan 300 mg/day, hydrochlorothiazide 12.5 mg/day and amlodipine 5 mg/day).

Sequential nephron blockade (spironolactone 25 mg/day, followed by sequential addition of furosemide 20 mg/day, furosemide 40 mg/day, and amiloride 5 mg/day if home BP ≥135/85 mmHg) added to baseline therapy.

Sequential renin-angiotensin system blockade (ramipril 5 mg/day, followed by sequential addition of ramipril 10 mg/day, bisoprolol 5 mg/day, and bisoprolol 10 mg/day if home BP ≥135/85 mmHg) added to baseline therapy.

Change in systolic daytime ambulatory blood pressure at week 12.surrogate