Hypertensive mediated organ damage evolution in resistant hypertension patients after adding spironolactone

Introduction: Resistant hypertension (RH) represents an important multi-organic impact and increases the morbi-mortality. We aimed to evaluate the evolution of hypertensive mediated organ damage in patients with RH after adding spironolactone. Material and methods: Retrospective study of 58 patients with RH who started spironolactone (12.5-25 mg daily). Office blood pressure, 24-h ambulatory blood pressure monitoring (24 hABPM), urine albumin-to-creatinine ratio and echocardiographic parameters were analyzed prior to initiation of spironolactone and after 12 months of treatment. Results: Thirty-six percent of patients were women and mean age was 67.3 +/- 10.1 years. We observed a decrease in urine albumin-to-creatinine ratio (median [RIQ25-75]) of 27.0 (7.5-255.4) to 11.3 (3.1-37.8) mg/g, p = 0.009. This was more relevant in patients with albuminuria grade A2 and A3: 371.2 (139.5-797.4) to 68.4 (26.5-186.5) mg/g, p = 0.02. The echocardiographic changes were: posterior wall thickness: -1.0 +/- 0.4 mm (p < 0.001), interventricular septal thickness: -0.6 +/- 0.5 mm (p = 0.01), left ventricular (LV) mass index: -14.7 +/- 10.2 g/m2 (p = 0.006), LV remodeling index: -0.04 +/- 0.036 (p = 0.03), without statistically significant changes in LV ejection fraction, LV end-diastolic diameter, LV end-systolic diameter, left atrial diameter, relationship between early ventricular filling wave and atrial contraction and LV filling pressure index. Systolic/diastolic office blood pressure decreased -12.5 +/- 4.9/-4.9 +/- 3.0 mmHg, p < 0.001. In 24 h-ABPM, systolic and diastolic BP had a significant decrease in diurnal and nocturnal periods and 38.1% of patients presented a favorable change in the circadian pattern, p < 0.001. Conclusions: Adding spironolactone to patients with RH contributes to improve hypertensive mediated organ damage by reducing albuminuria levels and echocardiographic parameters of hypertensive heart disease. (c) 2022 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Nefrologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/).