Abstract
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 ≥140mmHg 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 6months. Mean baseline-adjusted difference between the two groups (spironolactone vs renal denervation) at 6months in 24-hour systolic blood pressure was -17.9mmHg (95% confidence interval [CI], -30.9 to -4.9; P=.01). Mean baseline-adjusted change in urine albumin excretion was -87.2 (95% CI, -164.5 to -9.9) and -23.8 (95% CI, -104.5 to 56.9), respectively (P=.028). Mean baseline-adjusted variation of 24-hour pulse pressure was -13.5 (95% CI, -18.8 to -8.2) and -2.1 (95% CI, -7.9 to 3.7), respectively (P=.006). The correlation of change in 24-hour systolic blood pressure with change in log-transformed urine albumin excretion was r=.713 (P<.001). At 6months there was a reduction in albuminuria in patients with resistant hypertension treated with spironolactone as compared with renal denervation.
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