Hypertension is defined resistant (or refractory) when it is not possible to reach the target values of blood pressure despite the contemporary use of three antihypertensive drugs at optimised dosage (1). Today difficult control of hypertension is more and more frequent in clinical practice.In recent years the role of anti-aldosteronic agents has appeared useful in the treatment of resistant hypertension; this condition seems to be related to the increase of the mean age. Subjects suffering from resistant hypertension mostly show an isolated high systolic pressure. In addition to advanced age, factors commonly associated are: increased levels of aldosterone and intravascular volume, chronic kidney disease, diabetes mellitus, obesity; and therefore these subjects are more exposed to organ damage (2). In some recent trials anti-aldosteronic agents have demonstrated positive effects in ruling hypertension and in reducing organ damage (3) and among the different antialdosteronic agents canrenone showed a smaller occurrence of side effects (impotence and gynaecomastia in males, menstrual pains in females) and so a wider tolerability in comparison with spironolactone and eplerenone (4). However, hyperkalaemia is the most important side effect of all these agents; the principal contraindications are severe renal failure and high levels of serum potassium. Moreover it is necessary to use these drugs with attention if they are combined with ace-inhibitors or angiotensin II receptors blockers, because they can increase kalaemia too. ConclusionIn conclusion, scientific data indicate a positive role of these drugs both in the control of resistant hypertension and in the prevention (or at least in the reduction) of organ damage (5,6,7,8). For this reason, it is hoped that there will be a wider use of these agents in clinical practice, of course when they are not contraindicated.
|Stato di pubblicazione||Published - 2011|