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• W4242586957 abstract "Actually, there are few data about glomerular filtration rate (eGFR) drop in patients with resistant hypertension and how different therapies can modify chronic kidney disease progression (CKD). To evaluate CKD progression in patients with resistant hypertension undergoing two different therapies: treatment with spironolactone or furosemide. 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 m², 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). The mean annual eGFR decrease was −2.8 ± 5.4 ml / min / 1.73 m². In spironolactone group was −2.1 ± 4.8 ml / min / 1.73 m² and in furosemide group was −3.2 ± 5.6 ml / min / 1.73 m², p < 0.01. In patients received spironolactone, SBP decreased 23 ± 9 mmHg and in furosemide group decreased 16 ± 3 mmHg, p < 0, 01. DBP decreased 10 ± 8 mmHg and 6 ± 2 mmHg, respectively (p < 0.01). 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 < 0.01. 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 = 0.04), higher GFR (p = 0.01), lower albuminuria (p = 0.01), not diabetes mellitus (p = 0, 01) and treatment with spironolactone (p = 0.02). 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. 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. En la actualidad, existen pocos datos sobre la evolución de la función renal en pacientes con HTA resistente y enfermedad renal crónica (ERC), así como de la influencia de diferentes tipos de tratamiento en dicha progresión. Evaluar la progresión de la ERC en pacientes con ERC e hipertensión arterial resistente sometidos a dos estrategias terapéuticas diferentes: tratamiento con espironolactona versus furosemida. Incluimos 30 pacientes 21 H, 9 M con una edad media de 66,3 ± 9,1 años, FGe 55,8 ± 16,5 ml/min/1,73 m², PAS 162,8 ± 8,2 y PAD 90,2 ± 6,2 mmHg: 15 tratados con espironolactona y 15 con furosemida seguidos durante un tiempo medio de 32 meses (28–41). El descenso medio anual del FGe fue de -2,8 ± 5,4 ml/min/1,73 m². En el grupo de espironolactona fue de -2,1 ± 4,8 ml/min/1,73 m² y en el de furosemida -3,2 ± 5,6 ml/min/1,73 m², p < 0,01. En los pacientes con espironolactona la PAS disminuyó 23 ± 9 mmHg vs 16 ± 3 mmHg en el grupo de furosemida (p < 0,01). La PAD se redujo 10 ± 8 mmHg y 6 ± 2 mmHg respectivamente (p < 0,01). El tratamiento con espironolactona redujo la albuminuria de una mediana de 210 (121–385) mg/g a 65 (45–120) mg/g al final del seguimiento, p < 0,01. En el grupo de furosemida la albuminuria no descendió. La progresión más lenta en la enfermedad renal se asoció con una menor PAS (p = 0,04), mayor FGe basal (p = 0,01), menor albuminuria(p = 0,01), no tener diabetes mellitus (p = 0,01) y recibir tratamiento con espironolactona (p = 0,02). El tratamiento con espironolactona (OR 2,13 IC 1,89–2,29) y la menor albuminuria (OR 0,98 IC 0,97–0,99) mantienen su poder predictivo independiente en un modelo multivariante. El tratamiento con espironolactona reduce más la PA y la albuminuria en pacientes con HTA resistente comparado con la furosemida y esto se asocia con una progresión más lenta de la ERC a largo plazo." @default.
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• W4242586957 date "2020-01-01" @default.
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• W4242586957 title "Chronic kidney disease progression in patients with resistant hypertension subject to 2 therapeutic strategies: Intensification with loop diuretics vs aldosterone antagonists" @default.
• W4242586957 doi "https://doi.org/10.1016/j.nefroe.2019.04.004" @default.
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