Hypertension
Conditions
Keywords
resistant hypertension treatment, spironolactone, aldosterone antagonists, resistant arterial hypertension, refractory arterial hypertension
Brief summary
The purpose of this study is to evaluate the efficacy of spironolactone on lowering blood pressure when added to therapy in patients with resistant arterial hypertension.
Detailed description
Arterial hypertension resistant to therapy and requiring treatment with more then three antihypertensive drugs is common. At present there are is no standard therapy for resistant hypertension based on randomised clinical trials, neither data to guide addition of further drugs to therapy. Recently some observational and retrospective trials reported good effect of spironolactone in patients with resistant hypertension, but these data were not validated by prospective randomised clinical trials. This is a multicentric, randomised, double blind clinical trial, which will evaluate the effect of addition of 25 mg spironolactone to current medication compared to placebo. The study will enroll patients with blood pressure over 140/90 mmHg during a clinical examination, which are using at least three antihypertensive drugs, one of them being a diuretic. Average daytime systolic and diastolic blodd pressure will be evaluated by ABPM (ambulatory blood pressure monitoring).
Interventions
25 mg of spironolactone once daily or placebo for 2 months
Sponsors
Study design
Eligibility
Inclusion criteria
* Patients over 18 years * Resistant arterial hypertension: (blood pressure during clinical control exceeding 140/90 mmHg (or 130/80 mmHg in in diabetic patients or patients with renal disease with creatinine level of more than 133 μmol per liter or urinary protein excretion of more than 300 mg over a 24-hour period) despite adherence to treatment with full doses of at least three antihypertensive medications, including a diuretic
Exclusion criteria
* Pregnant or breastfeeding women, women in fertile age without ruled out pregnancy * Severe hypertension over 180/110 mmHg * Renal insufficiency with creatinine over 180 umol/l or GFR lower than 40 ml/min * Hyperkalemia over 5,4 mmol/l, hyponatremia below 130 mmol/l * Porphyria * Hypersensitivity to the compounds of Verospiron (Richter Gedeon, Hungary) drug * Patients taking any aldosterone antagonist (spironolactone, eplerenone, kanreone)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Average daytime systolic and diastolic blodd pressure evaluated by ABPM (ambulatory blood pressure monitoring) | before and after 2 months of treatment |
Secondary
| Measure | Time frame |
|---|---|
| changes of serum potassium, natrium, creatinine, body weight, casual blood pressure in office, treatment response for different baseline levels of aldosterone and aldosterone/PRA ratio | 2 months of follow-up |
Countries
Czechia