Spironolactone Versus Indapamide in Obese and Hypertensive Patients
Status:
Unknown status
Trial end date:
2020-12-01
Target enrollment:
Participant gender:
Summary
Most recent guidelines continue to recommend thiazide diuretics as first-line agents for
patients with hypertension in spite of the potential metabolic side effects, while
mineralocorticoid receptor antagonists (MRAs), such as spironolactone or eplerenone, are
mainly recommended to be used in patients with resistant hypertension or heart
failure.However,animal studies demonstrated that MRAs induce beneficial changes in left
ventricular remodeling and prevent or partially reverse cardiac fibrosis and pathological
hypertrophy that contribute to the development of diastolic heart failure. MRAs have also
been shown to decrease inflammation and myocardial fibrosis in patients with obesity and the
metabolic syndrome. In the proposed study, the investigators planned to randomize 400
patients with essential hypertension and increased waist circumference to receive
spironolactone or indapamide in combination with amlodipine for 12 months. The effects of the
two diuretics on target organ damage detected by changes in left atrial volume index(LAVI) by
echocardiography reflecting left ventricular diastolic dysfunction or changes in
carotid-femoral pulse wave velocity(PWV) reflecting arterial stiffness will be compared. The
potential role of MRAs as initial therapy for patients with essential hypertension and
visceral obesity will be evaluated.