EFFECT OF MINERALOCORTICOID RECEPTOR ANTAGONISTS ON THE ARTERIAL BLOOD PRESSURE LEVEL IN PATIENTS WITH DIFFERENT BODY MASS

Hyperaldosteronism plays a crucial role in the pathogenesis of resistant arterial hypertension. Increased aldosterone concentration often follows obesity. Mineralocorticoid receptor antagonists are expected to reduce the blood pressure (BP) in hypertensive patients, but the correlation between their efficiency and the body mass of patients has not been yet found. The efficiency of mineralocorticoid receptor antagonists in the complex therapy of resistant arterial hypertension in patients with normal body mass, overweight and obesity was compared in this study. The study included 54 non-black patients (21 men, 33 women, the mean age 54.5 ± 7.1 years) with resistant arterial hypertension defined as the baseline office BP of more than 140/90 mm Hg despite an intensive treatment with at least three antihypertensive agents, one of which was a diuretic. The main exclusion criteria were the secondary hypertension and the primary hyperaldosteronism. All patients were divided into 2 groups: 1st group (n = 24) included patients with the body mass index (BMI) < 25 kg/m2, 2nd one (n = 30) consisted of people with the increased BMI (≥ 25 kg/m²). Mineralocorticoid receptor antagonist spironolactone (25–50 mg/d) was additionally prescribed to all patients. On the baseline and after 6 month of treatment all patients underwent office BP measurements and 24-hour BP measurements with the mean systolic and diastolic BP assessment.  There were no significant differences in the level of the mean 24-hour BP (141.2 ± 3.6/84.7 ± 2.4 mm Hg in the 1st group and 141.2 ± 3.9/84.2 ± 1.8 mm Hg in the 2nd group) and antihypertensive therapy between the groups on the baseline (p > 0.05). After 6 month the mean 24-hour systolic and diastolic BP significantly reduced in the both groups (р < 0.05) with the greatest decrease (р = 0.02) in the 2nd group (mean 11.7 ± 0.5/5.8 ± 1.4 mm Hg) in comparison to the 1st group (mean 8.9 ± 0.7/3.9 ± 1.5 mm Hg). The target BP level was achieved in 12 (50 %) patients of the 1st group and in 24 (80 %) patients of the 2nd one (χ² = 4.13, p = 0.04).  Addition of mineralocorticoid receptor antagonists to the complex therapy of resistant arterial hypertension leads to a BP decrease, especially in patients with overweight and obesity.

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