1. Potassium binder therapy with patiromer can promote longer duration of spironolactone use for resistant hypertension in the setting of chronic kidney disease.
Evidence Rating Level: 1 (Excellent)
Spironolactone is recommended in the treatment of resistant hypertension, however there is limited data regarding its use in the setting of chronic kidney disease (CKD). In CKD, where the use of spironolactone for resistant hypertension may be limited by the risk of developing hyperkalemia, there may be a role for potassium binders such as patiromer. In the AMBER trial, a phase II, multi-centre, randomized, double-blind trial, 295 participants with CKD and resistant hypertension were randomized to receive patiromer 8.4g once daily or placebo for 12 weeks to evaluate the safety and efficacy of patiromer therapy as an adjunct to spironolactone and baseline blood pressure medications in the treatment of resistant hypertension. The primary outcome was the between-group difference in proportions of patients using spironolactone at week 12. Researchers found that 86% and 66% of patiromer and placebo-group participants remained on spironolactone therapy at week 12, respectively (between-group difference 19.5%, 95% CI 10.0% to 29.0%, p<0.0001). Adverse events were minor and comparable between groups. This study therefore shows that patiromer therapy may facilitate prolonged use of spironolactone therapy in patients with CKD and resistant hypertension.
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