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2015 ; 2
(ä): 3
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Mineralocorticoid Receptor Antagonists Therapy in Resistant Hypertension: Time to
Implement Guidelines!
#MMPMID26664875
Maiolino G
; Azzolini M
; Rossi GP
Front Cardiovasc Med
2015[]; 2
(ä): 3
PMID26664875
show ga
Despite the availability of anti-hypertensive medications with increasing
efficacy up to 50% of hypertensive patients have blood pressure levels (BP) not
at the goals set by international societies. Some of these patients are either
not optimally treated or are non-adherent to the prescribed drugs. However, a
proportion, despite adequate treatment, have resistant hypertension (RH), which
represents an important problem in that it is associated to an excess risk of
cardiovascular events. Notwithstanding a complex pathogenesis, an abundance of
data suggests a key contribution for the mineralocorticoid receptor (MR) in RH,
thus fostering a potential role for its antagonists in RH. Based on these
premises randomized clinical trials aimed at testing the efficacy of MR
antagonists (MRAs) in RH patients have been completed. Overall, they demonstrated
the efficacy of MRAs in reducing BP and surrogate markers of target organ damage,
such as microalbuminuria, either compared to placebo or to other drugs. In
summary, owing to the key role of the MR in the pathogenesis of RH and on the
proven efficacy of MRAs we advocate their inclusion as an essential component of
therapy in patients with presumed RH. Conversely, we propose that RH should be
diagnosed only in patients whose BP values show to be resistant to an up-titrated
dose of these drugs.