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Long-term effects of aldosterone blockade in resistant hypertension associated with chronic kidney disease

R Pisoni1, M C Acelajado, F R Cartmill

  • 1Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, USA. pisoni@musc.edu

Journal of Human Hypertension
|June 17, 2011
PubMed

Insights

Mineralocorticoid receptor antagonists (MRAs) effectively lower blood pressure in patients with resistant hypertension and stage 3 chronic kidney disease (CKD). However, close monitoring is crucial due to increased risks of hyperkalemia and declining kidney function.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Hypertension is a primary driver of chronic kidney disease (CKD) progression.
  • Mineralocorticoid receptor antagonists (MRAs) manage resistant hypertension but pose hyperkalemia risks in CKD patients.
  • Limited data exists on MRA efficacy and safety in stage 3 CKD with resistant hypertension.

Purpose of the Study:

  • To evaluate the long-term effects of MRAs on blood pressure control.
  • To assess the safety profile of MRAs in patients with resistant hypertension and stage 3 CKD.
  • To determine changes in serum potassium and renal function parameters.

Main Methods:

  • Retrospective analysis of 36 patients with resistant hypertension and stage 3 CKD.
  • Patients received MRAs (spironolactone or eplerenone) added to existing antihypertensive regimens.
  • Median follow-up duration was 312 days, with regular monitoring of blood pressure and biochemical parameters.

Main Results:

  • MRAs significantly reduced systolic blood pressure (162 to 138 mmHg) and diastolic blood pressure (87 to 74 mmHg).
  • Serum potassium levels increased (4.0 to 4.4 mEq/L), with one patient reaching 5.8 mEq/L.
  • Serum creatinine increased (1.5 to 1.8 mg/dL), and estimated glomerular filtration rate decreased (48.6 to 41.2 mL/min/1.73m²).
  • One case of acute renal failure and three cases of significant hyperkalemia were reported.

Conclusions:

  • MRAs demonstrate significant blood pressure-lowering effects in resistant hypertension with stage 3 CKD.
  • Treatment with MRAs necessitates vigilant biochemical monitoring for hyperkalemia and renal function.
  • The benefits of MRAs in this population must be weighed against the potential risks of adverse events.

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