Authors: Gaddam, Krishna K; Pratt-Ubunama, Monique N; Calhoun, David A

Source: Expert Review of Cardiovascular Therapy, Volume 4, Number 3, May 2006 , pp. 353-359(7)

Publisher: Expert Reviews

Abstract:

Resistant hypertension is defined as blood pressure that remains above target levels despite treatment with three different antihypertensive agents. Cross-sectional analyses and hypertension outcome studies indicate that it is a common clinical problem, which will undoubtedly become increasingly prevelant with an aging and increasingly overwight population. Secondary causes of hypertension are common in patients with resistant hypertension, particularly hyperaldosteronism, with a prevalence of approximately 15–20%. This, however, is likely to be an underestimation of the role excess aldosterone plays in causing resistance to treatment. In subjects with resistant hypertension, suppressed renin levels are common, exceeding 60% in studies conducted by the authors and from centers elsewhere in the world, suggesting occurrence of excess aldosterone beyond cases of true primary aldosteronism. Recent clinical studies indicate that aldosterone antagonists provide significant additional blood pressure reduction when added to treatment regimens of patients with resistant hypertension independent of aldosterone levels. These agents are generally well tolerated. Hyperkalemia is an uncommon complication of aldosterone antagonists, but it can occur. Therefore, biochemical monitoring is necessary, particularly in high-risk patients.

Keywords: aldosterone antagonists; amiloride; eplerenone; hyperaldosteronism; primary aldosteronism; resistant hypertension; spironolactone

Document Type: Research article

DOI: http://dx.doi.org/10.1586/14779072.4.3.353

Publication date: 2006-05-01

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• Expert Review of Cardiovascular Therapy provides expert commentary on the clinical applications of the new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage inculdes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery.
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