Resistant Hypertension and the Pivotal Role for Mineralocorticoid Receptor Antagonists: A Clinical Update 2016

Murray Epstein, Daniel Duprez

Research output: Contribution to journalReview article

19 Scopus citations

Abstract

True resistant hypertension must be distinguished from apparent resistant hypertension, of which important causes include medication nonadherence, illicit drug use, and alcoholism. Ambulatory blood pressure monitoring should be considered to rule out white coat hypertension. The pathogenesis is multifactorial, but the 2 pivotal factors include volume excess and the myriad effects of aldosterone. Aldosterone increases vascular tone because of endothelial dysfunction and enhances the pressor response to catecholamines. It also plays a crucial role in vascular remodeling of small and large arteries. Aldosterone also promotes collagen synthesis, which leads to increased arterial stiffness and elevation of blood pressure. Because aldosterone has been demonstrated to modulate baroreflex resetting, in cases of severe hypertension, there would be fewer compensatory mechanisms available to offset the blood pressure elevation.

Original languageEnglish (US)
Pages (from-to)661-666
Number of pages6
JournalAmerican Journal of Medicine
Volume129
Issue number7
DOIs
StatePublished - Jul 1 2016

Keywords

  • Aldosterone
  • Carotid baroreceptor stimulation
  • Mineralocorticoid receptor antagonists
  • Renal nerve denervation
  • Resistant hypertension
  • Spironolactone

Fingerprint Dive into the research topics of 'Resistant Hypertension and the Pivotal Role for Mineralocorticoid Receptor Antagonists: A Clinical Update 2016'. Together they form a unique fingerprint.

  • Cite this