PATHWAY-2

Prevention And Treatment of Hypertension With Algorithm-based therapY-2

Patient / Population Intervention / Exposition Comparaison Critère de jugement

In 335 patients with drug-resistant hypertension, add-on spironolactone lowered home systolic blood pressure more than placebo, bisoprolol, or doxazosin.

335

Schéma

Randomised, double-blind, placebo-controlled crossover trial

Critère

Difference in mean home systolic blood pressure between spironolactone and placebo (then vs bisoprolol and doxazosin)

Pertinence

RésultatSpironolactone reduced home systolic BP more than placebo (-8.70 mmHg, 95% CI -9.72 to -7.69; P<0.0001) and more than the mean of the two other add-ons (-4.26 mmHg), beating doxazosin (-4.03) and bisoprolol (-4.48) individually.

Williams B, et al. Lancet. 2015;386(10008):2059-2068. 10.1016/S0140-6736(15)00257-3

Discussion et critique

Crossover design with only 12-week cycles and a mostly white UK cohort limits long-term/outcome inference. Established spironolactone as the preferred fourth-line agent for resistant hypertension in major guidelines.