Chronic kidney disease progression in patients with resistant hypertension subject to 2 therapeutic strategies: Intensification with loop diuretics vs aldosterone antagonists

Introduction: Actualy, there are few data about glomerular filtration rate (eGFR) drop in patients with resistant hypertension and how diferent therapies can modify chronic kidney disease progression (CKD). Objective: To evaluate CKD progression in patients with resistant hypertension undergoing 2 diferent therapies: treatment with spironolactone or furosemide. Methods: We included 30 patients (21 M, 9 W) with a mean age of 66.3 +/- 9.1 years, eGFR 55.8 +/- 16.5 ml/min/1.73 m(2), SBP 162.8 +/- 8.2 and DBP 90.2 +/- 6.2 mmHg: 15 patients received spironolactone and 15 furosemide and we followed up them a median of 32 months (28-41). Results: The mean annual eGFR decrease was -2.8 +/- 5.4 ml/min/1.73 m(2). In spironolactone group was -2.1 +/- 4.8 ml/min/1.73 m(2) and in furosemide group was -3.2 +/- 5.6 ml/min/1.73 m(2), P<0.01. In patients received spironolactone, SBP decreased 23 +/- 9 mmHg and in furosemide group decreased 16 +/- 3 mmHg, P<.01. DBP decreased 10 +/- 8 mmHg and 6 +/- 2 mmHg, respectively (P<.01). Treatment with spironolactone reduced albuminuria from a serum albumin/creatine ratio of 210 (121-385) mg/g to 65 (45-120) mg/g at the end of follow-up, P<.01. There were no significant changes in the albumin/creatinine ratio in the furosemide group. The slower drop in kidney function was associated with lower SBP (P=.04), higher GFR (P=.01), lower albuminuria (P=.01), not diabetes mellitus (P=.01) and treatment with spironolactone (P=.02). Treatment with spironolactone (OR 2.13, IC 1.89-2.29) and lower albuminuria (OR 0.98, CI 0.97-0.99) maintain their independent predictive power in a multivariate model. Conclusion: Treatment with spironolactone is more effective reducing BP and albuminuria in patients with resistant hypertension compared with furosemide and it is associated with a slower progression of CKD in the long term follow up. (C) 2019 Sociedad Espanola de Nefrologia. Published by Elsevier Espana, S.L.U.