Abstract P624: Prevalence, Predictors and Comparison of Spironolactone versus Clonidine as a Fourth Drug for Resistant Hypertension: the Resistant Hypertension Optimal Treatment (ReHOT) study

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 68; no. suppl_1
• Main Authors: Krieger, Eduardo M, Drager, Luciano F, Giorgi, Dante M, Pereira, Alexandre C, Barreto-Filho, José A, Nogueira, Armando R, Mill, José G, Krieger, José E
• Format: Journal Article
• Language: English
• Published: 01.09.2016
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/hyp.68.suppl_1.p624

Abstract only Background: The prevalence, predictors and the best anti-hypertensive regimen for resistant hypertension (RH) are not well established especially in Countries with multiethnic profile. Our main aim was to compare spironolactone versus clonidine as a fourth drug therapy for patients with RH. Methods: This is a multicentric, randomized controlled trial comprising 26 sites in Brazil that recruited outpatients from a highly admixed population with hypertension stage 2 (≥160/100mmHg) at study entry. Medical therapy adherence was checked by pill counting. Patients with confirmed RH (no office and 24hs ambulatory blood pressure monitoring - ABPM - control despite treatment with 3 drugs including a diuretic for 12 weeks) were randomized to additional 12 weeks treatment with spironolactone (12.5-50mg once daily) or clonidine (0.1-0.3mg twice daily). The primary endpoint was blood pressure (BP) control from both office (<140/90mmHg) and 24hs ABPM (<130/80mmHg). Secondary endpoints included absolute and relative BP reductions in each study arm. Results: A total of 1597 patients were included in the analysis. We found that 14.9% (238 patients) fulfilled the RH criteria. Predictors of true RH include male gender (OR 1.43; CI 1.02-2.00), previous stroke (OR 2.81; CI 1.51-5.06), diabetes (OR 2.09; CI 1.48-2.94) and BP ≥180x110mmHg at study entry (OR 2.53; CI 1.88-3.43). Compared to patients randomized to spironolactone (n=119), those patients randomized to clonidine (n=119) presented similar rate of the primary endpoint (19.8 vs. 24%, respectively; p=0.59). Similarly, no differences were observed between groups in the blood pressure reduction analyzed either by office as well as by 24-h ABPM. No differences in the pill counting monitoring were observed in the groups. Conclusions: Appropriate treatment for stage 2 hypertension under the national universal health care conditions provided blood pressure control in 85% from a highly admixed population. Spironolactone or clonidine displayed comparable BP control as a fourth drug in patients with RH. Funding: Ministry of Health/H. Samaritano, National Research Council, Sao Paulo Research Foundation and Zerbini Foundation.