{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T14:04:18Z","timestamp":1776261858316,"version":"3.50.1"},"reference-count":17,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,7,21]],"date-time":"2015-07-21T00:00:00Z","timestamp":1437436800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:title>Abstrat<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>No consensus has been established as to which is the best fourth\u2010line agent in patients with resistant hypertension (<jats:styled-content style=\"fixed-case\">RHT<\/jats:styled-content>). The aim of the present study was to assess the effect of intensifying diuretic treatment with loop diuretic (furosemide) or aldosterone antagonist (spironolactone) on blood pressure (<jats:styled-content style=\"fixed-case\">BP)<\/jats:styled-content> control in <jats:styled-content style=\"fixed-case\">RHT<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study population comprised 30 patients with <jats:styled-content style=\"fixed-case\">RHT<\/jats:styled-content> who were divided into two treatment arms. Fifteen patients received furosemide 40\u2009mg\/day and 15 patients received spironolactone 25\u2009mg\/day. Ambulatory <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> monitoring was performed baseline, 3 and 6 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> was 162\u2009\u00b1\u20098\/90\u2009\u00b1\u20096\u2009mmHg, 70% men, mean age 63.3\u2009\u00b1\u20099.1 years 56.1% diabetic and estimated glomerular filtration rate (e<jats:styled-content style=\"fixed-case\">GFR)<\/jats:styled-content> 55.8\u2009\u00b1\u200916.5\u2009mL\/min per 1.73\u2009m<jats:sup>2<\/jats:sup>. There were no significant differences between groups at baseline in age, gender, percentage diabetics, <jats:styled-content style=\"fixed-case\">eGFR<\/jats:styled-content>, <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>, number of antihypertensive drugs, or aldosterone levels. At 6 months, systolic <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> decreased by 24\u2009\u00b1\u20099.2\u2009mmHg (from 163.6\u2009\u00b1\u20098.6 to 139.6\u2009\u00b1\u20098.1\u2009mmHg) in the spironolactone group, compared with 13.8\u2009\u00b1\u20092.8\u2009mmHg (from 162\u2009\u00b1\u20097.9 to 148\u2009\u00b1\u20096.4\u2009mmHg) in the furosemide group (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). Diastolic <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> fell 11\u2009\u00b1\u20098.1\u2009mmHg in the spironolactone group compared with 5.2\u2009\u00b1\u20092.2\u2009mmHg in the furosemide group (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). Significant reduction in urinary albumin creatinine ratio (from 173\u2009\u00b1\u2009268 to 14\u2009\u00b1\u200924\u2009mg\/g, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) was observed in the spironolactone group at 6 months. Multiple regression analysis showed that only treatment with spironolactone was associated with control of <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>\u2009&lt;\u2009140\/90\u2009mmHg at 6 months. No severe adverse events were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Spironolactone is more effective than furosemide for control of <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">RHT<\/jats:styled-content> patients, with a positive added effect on albuminuria. Spironolactone is safe in patients with mild kidney impairment, although serum potassium should be closely monitored, especially in diabetics.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nep.12475","type":"journal-article","created":{"date-parts":[[2015,3,30]],"date-time":"2015-03-30T04:14:14Z","timestamp":1427688854000},"page":"567-571","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Management of resistant hypertension: Aldosterone antagonists or intensification of diuretic therapy?"],"prefix":"10.1111","volume":"20","author":[{"given":"Ursula","family":"Verdalles","sequence":"first","affiliation":[{"name":"Department of Nephrology Hospital General Universitario Gregorio Mara\u00f1on  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soledad","family":"Garc\u00eda de Vinuesa","sequence":"additional","affiliation":[{"name":"Department of Nephrology Hospital General Universitario Gregorio Mara\u00f1on  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marian","family":"Goicoechea","sequence":"additional","affiliation":[{"name":"Department of Nephrology Hospital General Universitario Gregorio Mara\u00f1on  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Mac\u00edas","sequence":"additional","affiliation":[{"name":"Department of Nephrology Hospital General Universitario Gregorio Mara\u00f1on  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alba","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Nephrology Hospital General Universitario Gregorio Mara\u00f1on  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Perez de Jose","sequence":"additional","affiliation":[{"name":"Department of Nephrology Hospital General Universitario Gregorio Mara\u00f1on  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo","family":"Verde","sequence":"additional","affiliation":[{"name":"Department of Nephrology Hospital General Universitario Gregorio Mara\u00f1on  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Yuste","sequence":"additional","affiliation":[{"name":"Department of Nephrology Hospital General Universitario Gregorio Mara\u00f1on  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Lu\u00f1o","sequence":"additional","affiliation":[{"name":"Department of Nephrology Hospital General Universitario Gregorio Mara\u00f1on  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,7,21]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.0000259805.18468.8c"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfs420"},{"key":"e_1_2_5_4_1","first-page":"337","article-title":"KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease","volume":"2","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group","year":"2012","journal-title":"Kidney Int. 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