Managing resistant hypertension: focus on mineralocorticoid-receptor antagonists

Abstract

Juan Carlos Yugar-Toledo,1 Rodrigo Modolo,2 Ana Paula de Faria,2 Heitor Moreno2 1São José do Rio Preto Medicine School – FAMERP, São José do Rio Preto, 2School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil Abstract: Mineralocorticoid-receptor antagonists (MRAs) have proven to be effective in some types of hypertension, especially in resistant hypertension (RHTN). In this phenotype of hypertension, the renin–angiotensin–aldosterone pathway plays an important role, with MRAs being especially effective in reducing blood pressure. In this review, we show the relevance of aldosterone in RHTN, as well as some clinical characteristics of this condition and the main concepts involving its pathophysiology and cardiovascular damage. We analyzed the mechanisms of action and clinical effects of two current MRAs – spironolactone and eplerenone – both of which are useful in RHTN, with special attention to the former. RHTN represents a significant minority (10%–15%) of hypertension cases. However, primary-care physicians, cardiologists, nephrologists, neurologists, and geriatricians face this health problem on a daily basis. MRAs are likely one of the best pharmacological options in RHTN patients; however, they are still underused. Keywords: resistant hypertension, aldosterone, aldosteronism, mineralocorticoid-receptor antagonists, spironolactone, eplerenone

Keywords

• Resistant hypertension
• aldosterone
• hyperaldosteronism
• mineralocorticoid receptor antagonists
• spironolactone
• eplerenone.