Organ damage changes in patients with resistant hypertension randomized to renal denervation or spironolactone: The <scp>DENERVHTA</scp> (Denervación en Hipertensión Arterial) study

  • Anna Oliveras
    Nephrology Department Hospital del Mar Barcelona Spain
  • Pedro Armario
    Internal Medicine Department Vascular Risk Area Hospital Moisés Broggi Consorci Sanitari Integral University of Barcelona Barcelona Spain
  • Laia Sans
    Nephrology Department Hospital del Mar Barcelona Spain
  • Albert Clarà
    IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
  • Susana Vázquez
    Nephrology Department Hospital del Mar Barcelona Spain
  • Luis Molina
    IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
  • Júlia Pareja
    Internal Medicine Department Hospital de l'Esperit Sant Santa Coloma de Gramenet Spain
  • Alejandro de la Sierra
    Internal Medicine Department Hospital Mútua Terrassa University of Barcelona Barcelona Spain
  • Julio Pascual
    Nephrology Department Hospital del Mar Barcelona Spain

説明

<jats:p>Renal denervation and spironolactone have both been proposed for the treatment of resistant hypertension, but their effects on preclinical target organ damage have not been compared. Twenty‐four patients with 24‐hour systolic blood pressure ≥140 mm Hg despite receiving three or more full‐dose antihypertensive drugs, one a diuretic, were randomized to receive spironolactone or renal denervation. Changes in 24‐hour blood pressure, urine albumin excretion, arterial stiffness, carotid intima‐media thickness, and left ventricular mass index were evaluated at 6 months. Mean baseline‐adjusted difference between the two groups (spironolactone vs renal denervation) at 6 months in 24‐hour systolic blood pressure was −17.9 mm Hg (95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>], −30.9 to −4.9; <jats:italic>P</jats:italic> = .01). Mean baseline‐adjusted change in urine albumin excretion was −87.2 (95% <jats:styled-content style="fixed-case">CI</jats:styled-content>, −164.5 to −9.9) and −23.8 (95% <jats:styled-content style="fixed-case">CI</jats:styled-content>, −104.5 to 56.9), respectively (<jats:italic>P </jats:italic>=<jats:italic> </jats:italic>.028). Mean baseline‐adjusted variation of 24‐hour pulse pressure was −13.5 (95% <jats:styled-content style="fixed-case">CI</jats:styled-content>, −18.8 to −8.2) and −2.1 (95% <jats:styled-content style="fixed-case">CI</jats:styled-content>, −7.9 to 3.7), respectively (<jats:italic>P </jats:italic>=<jats:italic> </jats:italic>.006). The correlation of change in 24‐hour systolic blood pressure with change in log‐transformed urine albumin excretion was <jats:italic>r </jats:italic>= .713 (<jats:italic>P </jats:italic><<jats:italic> </jats:italic>.001). At 6 months there was a reduction in albuminuria in patients with resistant hypertension treated with spironolactone as compared with renal denervation.</jats:p>

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