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J Hum Hypertens. 2015 Mar;29(3):159-66. doi: 10.1038/jhh.2014.64. Epub 2014 Jul 31.

Effect of aldosterone antagonists on blood pressure in patients with resistant hypertension: a meta-analysis.

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Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.


There is currently limited data on which drug should be used to improve blood pressure (BP) control in patients with resistant hypertension (RH). We performed a systematic review and meta-analysis of published studies evaluating the anti-hypertensive benefit of aldosterone antagonists (AA) as an add-on therapy in patients with RH. A systematic literature search for eligible studies was conducted until June 2014, using literature databases and hand search. Studies were stratified according to controlled vs uncontrolled design and analyzed using random-effect models. We identified 13 eligible studies involving a total of 2640 patients, consisting of 3 randomized controlled trials, and 10 observational studies without a control group. In controlled studies, there was a reduction in mean systolic and diastolic BP of -16.5 (95% confidence interval (CI), -30.0 to -3.0) and -4.1 (95% CI, -7.8 to -0.32) mm Hg, respectively, compared with control. In uncontrolled studies, there was a reduction in mean systolic and diastolic BP of -19.7 (95% CI, -23.2 to -16.2) and -9.1 (95% CI, -10.3 to -7.8) mm Hg, respectively, compared with pre-AA therapy. Subgroup analysis showed that the systolic BP change was more pronounced in patients with baseline systolic BP >150 mm Hg (weighted mean difference (WMD), -23.1 mm Hg) than in patients with ⩽150 mm Hg (WMD, -15.4 mm Hg) (between groups P<0.001), suggesting that the baseline systolic BP was a predictor of the BP response to AA treatment. Furthermore, AA demonstrated a mild increase in serum potassium and creatinine (for both, P<0.001). The findings suggest that AA as an add-on therapy was effective for lowering systolic and diastolic BP in patients with RH.

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