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Publications

Journal Article Ahead of print 2 citations

PubMed: 40859651 DOI: 10.1002/bcp.70249

Effects of different antihypertensive drug classes on central and ambulatory blood pressure in resistant hypertension: A randomized clinical trial.

Br J Clin Pharmacol

Authors: Juan Carlos Yugar-Toledo, Tatiana Palotta Minari, Priscilla Galisteu de Mello, Elizabeth do Espirito Santo Cestario, Tatiane de Azevedo Rubio, Larissa Morete Caieiro da Costa, Louise Bounalume Tácito Yugar, Luis Gustavo Sedenho-Prado, Lúcia Helena Bonalume Tacito, Luciana Neves Cosenso-Martin, André Fattori, Luciana Pellegrini Pisani, José Fernando Vilela-Martin, Heitor Moreno

Affiliations

  • Hypertension Clinic, Department of Internal Medicine, State Medical School of São José do Rio Preto, São Paulo, Brazil.
  • Faculty of Medical Sciences, State University of Campinas, Brazil.
  • Endocrinology Division of the Internal Medicine Department, State Medical School of São José Rio Preto, São Paulo, Brazil.
  • Department of Bioscience, Federal University of São Paulo, Santos, SP, Brazil.

Abstract

AIMS

This study compares sequential nephron blockade (SNB) and renin-angiotensin system sequential blockade (RASSB) in patients with resistant hypertension (RHTN), evaluating central systolic pressure, arterial stiffness, pulse pressure (PP) and ambulatory blood pressure monitoring (ABPM).

METHODS

Seventy-two RHTN patients were randomly assigned to SNB (n = 35, 22 females, 13 males) or RASSB (n = 37, 22 females, 15 males). SNB included multiple diuretics (furosemide, spironolactone, hydrochlorothiazide) to enhance natriuresis and counter intra-renal compensatory mechanisms. RASSB employed stepwise renin-angiotensin system blockade using lisinopril, bisoprolol and losartan, even in patients already on valsartan.

RESULTS

Office blood pressure reductions were significant in both groups (P < 0.0001). SNB: systolic blood pressure (SBP) from 174.5 to 127.0 mmHg, diastolic blood pressure (DBP) from 105.3 to 78.11 mmHg.

RASSB

SBP from 178.4 to 134.4 mmHg, DBP from 102.7 to 77.33 mmHg. ABPM confirmed 24-h reductions (P < 0.0001). SNB showed greater PP reduction (Δ = 22.99 vs 15.93 mmHg, P = 0.024) and central systolic pressure reduction (Δ = -10.3 vs -5.1 mmHg, P = 0.036). RASSB produced a pronounced heart rate decrease (Δ = -12.4 beats per minute, P < 0.0001). No treatment-related discontinuations occurred.

CONCLUSION

SNB demonstrated superior efficacy in reducing central SBP and PP, while RASSB more effectively lowered heart rate. These distinct hemodynamic responses support individualized treatment strategies for patients with RHTN.

CLINICALTRIALS

gov identifier: NCT02832973.

MeSH

Hypertension, Blood, Pharmaceutical Preparations, Heart Rate, Heart, Blood Pressure, Renin, Antihypertensive Agents, Angiotensins, Pharmacology, Blood Pressure Monitoring, Ambulatory, Bisoprolol, Therapeutics, Natriuretic Agents, Renin-Angiotensin System