L.A. Mishchenko, O.O. Matova, M.Yu. Sheremet, K.I. Serbeniuk Comparative efficacy of spironolactone, eplerenone, nebivolol and moxonidine in patients with resistant arterial hypertension

The aim – to study the effectiveness of spironolactone, eplerenone, nebivolol, moxonidine as the 4th component of therapy in patients with resistant arterial hypertension.

Material and methods. The study involved 66 patients with true resistant arterial hypertension (RAH). The average age of patients was 51.9±1.2 years, mostly men (59.1 %). In addition to standard triple-dose fixed combination antihypertensive tharepy, all patients received in turn spironolactone (45.0±3.6 mg/day), eplerenone (47.9±2.1 mg/day), nebivolol (8.9±0.6 mg/day) and moxonidine (0.5±0.1 mg/day). After completion of each stage, after 3 months of therapy, all patients have been assessed an office blood pressure measurements and ABPM.

Results. In patients with RAH, the addition standardized therapy with a triple fixed-dose combination of antihypertensive drugs, antagonists of mineralocorticoid showed better effectiveness than nebivolol and moxonidine: the target level of BP with treatment of spironolactone was achieved in 68.2 % patients, eplerenone – 65.2 %, whereas in the groups of nebivolol and moxonidine – in 53.9 % and 56.2 %, respectively. The predictors of the effectiveness of the antagonists of the mineralocorticoid receptors are increasing plasma aldosterone concentrations (β=0.653; Р=0.002) and ARR values (β=0.542; Р=0.003), while the β-blocker and imidazolin receptor agonist were more effective in older patients (β=0.425; Р=0.02) along with increase of average daily pulse (β=0.315; P=0.04) and excretion of urine metanephrines (β=0.382; Р=0.01).

Conclusoins. Spironolactone and eplerenone are drugs of choice for adding to triple fixed-dose combination in patients with RAH. They were significantly more effective than beta-blocker (nebivolol) and an imidazolin receptor agonist (moxonidine).

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