Key result
Mineralocorticoid receptor antagonists reduced systolic blood pressure by 7.4 mmHg more than other active 4th-line comparators in randomized studies of patients with resistant hypertension.
Why the study?
Do mineralocorticoid receptor antagonists reduce systolic blood pressure more effectively than other fourth-line agents in patients with resistant hypertension?
Meta-Analysis (n=755)
Do mineralocorticoid receptor antagonists reduce systolic blood pressure more effectively than other fourth-line agents in patients with resistant hypertension?
Mean Difference: 7.4 (95% CI 3.2–11.6)
In patients with resistant hypertension, mineralocorticoid receptor antagonists (spironolactone) provide superior systolic blood pressure reduction compared to alternative fourth-line agents, though with an increased risk of hyperkalemia.
Supports MRA use in resistant hypertension; confirms randomized efficacy in this meta-analysis.
test and corresponding 95% confidence intervals. From 2,506 records, 5 studies met our inclusion criteria with 755 included patients. Two studies were randomised and three were non-randomised. Comparative fourth-line agents included bisoprolol, doxazosin, furosemide and additional blockade of the renin angiotensin-aldosterone system. Using data from randomised studies, mineralocorticoid receptor antagonists reduced blood pressure by 7.4 mmHg (95%CI 3.2 - 11.6) more than the active comparator. When limited to non-randomised studies, mineralocorticoid receptor antagonists reduced blood pressure by 11.9 mmHg (95% CI 9.3 - 14.4) more than the active comparator. Conclusion On the basis of this meta-analysis, mineralocorticoid receptor antagonists reduce blood pressure more effectively than other fourth-line agents in resistant hypertension. Effectiveness stratified by ethnicity and comorbidities, in addition to information on clinical outcomes such as myocardial infarction and stroke, now needs to be determined.
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Sinnott et al. (2016) conducted a meta-analysis in Resistant hypertension (n=755). Mineralocorticoid receptor antagonists (spironolactone) vs. Other 4th line anti-hypertensive agents (bisoprolol, doxazosin, furosemide, additional RAAS blockade) was evaluated on Change in systolic blood pressure (MD 7.4 mmHg greater reduction, 95% CI 3.2-11.6). Mineralocorticoid receptor antagonists reduced systolic blood pressure by 7.4 mmHg more than other active 4th-line comparators in randomized studies of patients with resistant hypertension.
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