Key result
Canrenone addition to ACE inhibitors or AT1R antagonists plus HCT was associated with a significant reduction of 24 h BP and an increased number of patients meeting 24 h ABPM targets.
Why the study?
Does the addition of canrenone reduce ambulatory blood pressure in patients with uncontrolled stage 1 or 2 hypertension on maximum tolerated ACEi/ARB plus HCT?
RCT (n=158)
randomized
Does the addition of canrenone reduce ambulatory blood pressure in patients with uncontrolled stage 1 or 2 hypertension on maximum tolerated ACEi/ARB plus HCT?
The addition of canrenone to maximum tolerated ACEi/ARB plus hydrochlorothiazide significantly reduces 24-hour ambulatory blood pressure in patients with uncontrolled hypertension.
Supports adding canrenone for improved 24 h BP control on ACEi/ARB plus HCT; extends RCT evidence for mineralocorticoid antagonism in resistant hypertension.
BACKGROUND: Blockade of the renin-angiotensin-aldosterone system is a cornerstone in cardiovascular disease prevention and hypertension treatment. The relevance of ambulatory blood pressure monitoring (ABPM) has been widely confirmed for both increasing the accuracy of blood pressure (BP) measurements, particularly in pharmacological trials, and focusing on 24 h BP prognostic parameters. The aim of this study was to assess the effects of canrenone addition on ambulatory BP in uncontrolled hypertensive patients already treated with the highest tolerated dose of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor (AT1R) antagonists plus hydrochlorothiazide (HCT). METHODS: ABPM was performed at baseline and after 3 months of combination therapy in 158 outpatients with stage 1 or 2 hypertension who were randomized to add canrenone (50 or 100 mg) to the pre-existing therapy with ACE inhibitors or AT1R antagonists plus HCT. Twenty-four-hour systolic and diastolic BPs were considered normalized when the values were <130 and <80 mmHg, respectively. RESULTS: = not significant for 50 vs 100 mg). The percentage of patients whose nocturnal decrease was >10% with respect to diurnal values did not change during combination therapy. CONCLUSION: Canrenone addition to ACE inhibitors or AT1R antagonists plus HCT was associated with a significant reduction of 24 h BP and to an increased number of patients meeting 24 h ABPM targets in a clinical setting of uncontrolled stage 1 or 2 hypertension.
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Guasti et al. (2017) conducted an RCT in uncontrolled stage 1 or 2 hypertension (n=158). canrenone vs. canrenone 50 mg vs 100 mg was evaluated on 24-hour systolic and diastolic blood pressure. Canrenone addition to ACE inhibitors or AT1R antagonists plus HCT was associated with a significant reduction of 24 h BP and an increased number of patients meeting 24 h ABPM targets.
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