LONDON – Spironolactone is far and away the most effective therapy for resistant hypertension, according to the findings of the first randomized clinical trial comparing the aldosterone antagonist with other active agents.
“The result in favor of spironolactone is unequivocal: Spironolactone is the most effective treatment for resistant hypertension, and these results should influence treatment guidelines globally,” Dr. Bryan Williams said in presenting the PATHWAY-2 (Optimum Treatment for Drug-Resistant Hypertension) trial findings at the annual congress of the European Society of Cardiology.
Indeed, on the basis of the drug’s performance – a mean reduction in home systolic blood pressure of 8.7 mm Hg, compared with reductions of 4.03 and 4.48 mm Hg for doxazosin and bisoprolol, respectively, in the 314-patient crossover study – no one should any longer be categorized as having treatment-resistant hypertension unless they’ve first failed to achieve blood pressure control on spironolactone. And that will be a surprisingly small group, the chair of medicine at University College London said in an interview.