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Abstract: PO2097

Renal Denervation (RDN) vs. Spironolactone in the Treatment of Resistant Hypertension (RH): A Meta-Analysis

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Edding, Sherida Naing, St. Luke's Medical Center - Global City, Taguig City, Philippines
  • Cating-Cabral, Monica Therese, St. Luke's Medical Center - Global City, Taguig City, Philippines
  • Cabral, Brian Michael I., St. Luke's Medical Center - Global City, Taguig City, Philippines
Background

Resistant hypertension (RH) is defined as blood pressure that remains above guideline-directed goal despite the concurrent use of at least three antihypertensive agents of different classes, one of which is a diuretic. Treatment of RH is focused on the addition of fourth-line therapy. Several studies revealed impressive blood pressure reductions when spironolactone was added to the therapeutic regimen. In the recent years, there has been a growing perception that controlling blood pressure in resistant hypertension is beyond the reach of existing drug therapies, leading to the emergence of device-based therapies, such as renal denervation. Our aim is to do a systematic review of randomized controlled trials that compares the use of Spironolactone and Renal Denervation in patients with RH.

Methods

A comprehensive literature search from the PubMed, Embase, Cochrane Library, and Ovid was performed with the following search terms: Resistant Hypertension, Spironolactone, Renal Denervation. The search was limited to randomized-controlled trials that compared Spironolactone to Renal Denervation in patients with Resistant Hypertension. Three prospective clinical trials were selected and analyzed using Cochrane Revman v5.3. Primary outcome were mean changes in 24-hour Ambulatory Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP). Secondary outcomes include mean changes in Office SBP and DBP. Safety was assessed by changes in eGFR and potassium levels.

Results

Two trials comprising 130 patients were selected - 63 patients treated with RDN and 67 patients with Spironolactone. Pooled analysis of the 2 trials for 24H SBP and DBP showed an adjusted standardized mean difference of 0.55 mmHg (CI -0.72, 1.82; P = 0.39) and 0.32 mmHg (CI -0.72, 1.35; P = 0.55) with significant heterogeneity. No significant differences were also noted in terms of decline in eGFR (p = 0.07) and changes in serum potassium (p = 0.29) from baseline to 6 months.

Conclusion

Based on our results, RD appears to be safe and effective treatment for RH. However, additional larger studies should be done including a cost-benefit analysis to explore that possibility of RD as treatment alternative for those intolerant of spironolactone or as a possible 5th line of treatment for those already taking spironolactone.