November 30, 2015

Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial

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This is a double-blind, placebo-controlled, crossover trial in patients with resistant hypertension that were taking maximally tolerated doses of 3 or more drugs. The authors found that the average reduction in home systolic blood pressure by spironolactone was superior to placebo (-8•70 mm Hg [95% CI -9•72 to -7•69]; p<0•0001), superior to the mean of the other two active treatments (doxazosin and bisoprolol; -4•26 [-5•13 to -3•38]; p<0•0001), and superior when compared with the individual treatments; versus doxazosin (-4•03 [-5•04 to -3•02]; p<0•0001) and versus bisoprolol (-4•48 [-5•50 to -3•46]; p<0•0001). This supports the role of sodium retention in resistant hypertension.

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Clinical Nephrology, Clinical Trial Results, Hypertension