Spironolacton in the therapy of resistant hypertension

Hypertension is the most common chronic non-communicable disease, and it is estimated that about 7 million deaths a year are associated with poor regulation of blood pressure. In addition, these patients have a higher incidence of disability as well as increased treatment costs. One of the most important causes of poor blood pressure regulation is resistant hypertension. Due to all the above, in the last decade, there has been an increase in researchers' interest in studying the pathogenesis, diagnosis and treatment of resistant hypertension. However, the latest data indicate that 20% of women and 24% of men with arterial hypertension still have poor regulation of blood pressure, despite the use of maximum doses of three antihypertensive drugs (including diuretics) and an appropriate lifestyle. In these patients, the recommendations advise the introduction of mineralocorticoid receptor antagonists as a fourth-line drug, and in case of unsatisfactory therapeutic effect, consideration of new treatment modalities (renal catheter denervation and baroreceptor stimulation). In this article, we summarize the current knowledge on different pathogenetic mechanisms and adequate diagnostic approaches in patients with resistant hypertension. We also gave an overview of current therapeutic approaches, with special reference to spironolactone.