Spironolactone was the most effective add-on drug for the treatment of resistant hypertension in a double-blind, placebo-controlled study of 285 randomly assigned patients aged 18 to 79 years who received spironolactone, doxazosin, biosoprolol, and placebo in addition to their baseline blood pressure medications. Participants had seated clinic systolic blood pressure (BP) of ≥140 mm Hg and home systolic BP of ≥130 mm Hg, despite treatment for at least 3 months with maximally tolerated doses of 3 drugs. Researchers found:

• Average reduction in home systolic BP by spironolactone was superior to placebo (-8.70 mm Hg).

• Average reduction in home systolic BP by spironolactone was superior to the mean of other 2 active treatments (doxazosin and bisoprolol; 4.26 mm Hg) and when compared with the individual treatments vs doxazosin (-4.03 mm Hg) and vs. bisoprolol (-4.48 mm Hg).

• Superiority of spironolactone supports a primary role of sodium retention in patients with resistant hypertension.

Citation: Williams B, MacDonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomized, double-blind, crossover trial. Lancet. [Published online ahead of print September 21, 2015]. doi: 10.1016/S0140-6736(15)00257-3.