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Título : Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension
Otros títulos : Clinical Study: Resistant Hypertension Optimal Treatment Trial (ReHOT)
Autor : Guimarães, Armênio Costa
Krieger, Eduardo M.
Drager, Luciano F.
Giorgi, Dante M.A.
Pereira, Alexandre C.
Barreto-Filho, José Augusto Soares
Nogueira, Armando R.
Mill, José Geraldo
Lotufo, Paulo A.
Amodeo, Celso
Batista, Marcelo C.
Bodanese, Luiz C.
Carvalho, Antônio C.C.
Castro, Iran
Chaves, Hilton
Costa, Eduardo A.S.
Feitosa, Gilson S.
Franco, Roberto J.S.
Fuchs, Flávio D.
Jardim, Paulo C.
Machado, Carlos A.
Magalhães, Maria E.
Mion Jr, Décio
Nascimento, Raimundo M.
Nobre, Fernando
Nóbrega, Antônio C.
Ribeiro, Antônio L.P.
Rodrigues-Sobrinho, Carlos R.
Sanjuliani, Antônio F.
Teixeira, Maria do Carmo B.
Krieger, José E.
Palabras clave : Blood pressure; Clinical trial; Humans; Hypertension; Risk; Therapeutics
Fecha de publicación : abr-2018
Resumen : The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5–50 mg QD) or clonidine (0.1–0.3 mg BID). The primary end point was BP control during office (<140/90 mmHg) and 24-h ambulatory (<130/80 mmHg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55–1.88]; P=1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy.
URI : http://www7.bahiana.edu.br//jspui/handle/bahiana/2979
ISSN : 681-690
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