Abstract 093: Could Spironolactone Be More Effective Than Sympathetic Renal Denervation to Treat True Resistant Hypertension? Preliminary Results From the DENERVHTA Study.

Abstract

Aim: To compare the efficacy and safety between two therapeutic strategies to reduce 24h-SBP in patients with resistant hypertension: renal denervation or the addition of spironolactone. Methods: Twenty-one patients with office-SBP ≥150 mmHg and 24h-SBP≥140 mmHg despite receiving ≥3 full-dose antihipertensive drugs, one a diuretic, but without aldosterone antagonists, were randomized to renal denervation (by Simplicity®) or to spironolactone (25-50 mg), as add-on therapy. Changes in both office- (3 averaged readings) and 24h- BP (by Spacelabs®-90207) were evaluated at 6 months. Comparisons between treatment groups were performed using analysis of variance adjusted by age, gender and baseline values. Results: mean age was 62.7 ± 7.6 yr; men: 61.9% (13 of 21); diabetes: 47,6% (10 of 21). Mean BMI: 32.3 ± 6.1 Kg/m 2 . Duration of hypertension: 13.4 ± 7.2 yr. Number of antihypertensive drugs: 4,1 ± 0,7. Mean office-BP: 167,5 ± 20,1 / 91,7 ± 12,4 mmHg. Mean 24h-BP: 151,8 ± 9,1 / 81,7 ± 8,4 mmHg. Baseline characteristics were not different between groups (p=NS for all). Comparison between groups of main changes over time is shown in Table. Reduction of 24h-SBP was higher in the spironolactone group after adjusting by age, sex and baseline 24h-SBP (p=0.016). Reduction of eGFR was higher in the spironolactone group after adjusting by baseline eGFR (p=0.033). Conclusions: 1) As compared to renal denervation, spironolactone was more effective to reduce 24h-SBP after 6 months in patients with resistant hypertension. These differences were not significant as regards office-BP. 2) Spironolactone add-on treatment significantly decreased eGFR as compared to renal denervation treatment.