Causes, Evaluation, and Treatment of Secondary and Resistant Hypertension
By:
Gregory L. HundemerDivision of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada

Search for other papers by Gregory L. Hundemer in
Current site
Google Scholar
PubMed
Close
  • Collapse
  • Expand
  • 1

    Whelton PK, Carey RM, Aronow WS, Casey Jr DE, Collins KJ, Dennison Himmelfarb C, et al.: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension 71: e13e115, 2018

    • Search Google Scholar
    • Export Citation
  • 2

    Carey RM, Calhoun DA, Bakris GL, Brook RD, Daugherty SL, Dennison-Himmelfarb CR, et al.; American Heart Association Professional/Public Education and Publications Committee of the Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Genomic and Precision Medicine; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council: Resistant hypertension: Detection, evaluation, and management: A scientific statement from the American Heart Association. Hypertension 72: e53e90, 2018 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Brown JM, Robinson-Cohen C, Luque-Fernandez MA, Allison MA, Baudrand R, Ix JH, et al.: The spectrum of subclinical primary aldosteronism and incident hypertension: A cohort study. Ann Intern Med 167: 630641, 2017 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Brown JM, Siddiqui M, Calhoun DA, Carey RM, Hopkins PN, Williams GH, et al.: The unrecognized prevalence of primary aldosteronism: A cross-sectional study. Ann Intern Med 173: 1020, 2020 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Joseph JJ, Pohlman NK, Zhao S, Kline D, Brock G, Echouffo-Tcheugui JB, et al.: Association of serum aldosterone and plasma renin activity with ambulatory blood pressure in African Americans: The Jackson heart study. Circulation 143: 23552366, 2021 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Carey RM, Sakhuja S, Calhoun DA, Whelton PK, Muntner P: Prevalence of apparent treatment-resistant hypertension in the United States. Hypertension 73: 424431, 2019 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Tanner RM, Calhoun DA, Bell EK, Bowling CB, Gutiérrez OM, Irvin MR, et al.: Prevalence of apparent treatment-resistant hypertension among individuals with CKD. Clin J Am Soc Nephrol 8: 15831590, 2013 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Sim JJ, Bhandari SK, Shi J, Reynolds K, Calhoun DA, Kalantar-Zadeh K, et al.: Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension. Kidney Int 88: 622632, 2015 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Thomas G, Xie D, Chen HY, Anderson AH, Appel LJ, Bodana S, et al.; CRIC Study Investigators: Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: Report from the chronic renal insufficiency cohort study. Hypertension 67: 387396, 2016 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Bhatt H, Siddiqui M, Judd E, Oparil S, Calhoun D: Prevalence of pseudoresistant hypertension due to inaccurate blood pressure measurement. J Am Soc Hypertens 10: 493499, 2016 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Ruzicka M, Leenen FHH, Ramsay T, Bugeja A, Edwards C, McCormick B, et al.: Use of directly observed therapy to assess treatment adherence in patients with apparent treatment-resistant hypertension. JAMA Intern Med 179: 14331434, 2019 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Egan BM, Zhao Y, Li J, Brzezinski WA, Todoran TM, Brook RD, et al.: Prevalence of optimal treatment regimens in patients with apparent treatment-resistant hypertension based on office blood pressure in a community-based practice network. Hypertension 62: 691697, 2013 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Egan BM, Zhao Y, Axon RN, Brzezinski WA, Ferdinand KC: Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008. Circulation 124: 10461058, 2011 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    McMahon EJ, Bauer JD, Hawley CM, Isbel NM, Stowasser M, Johnson DW, et al.: A randomized trial of dietary sodium restriction in CKD. J Am Soc Nephrol 24: 20962103, 2013 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J: The effect of a reduction in alcohol consumption on blood pressure: A systematic review and meta-analysis. Lancet Public Health 2: e108e120, 2017 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Lopes S, Mesquita-Bastos J, Garcia C, Bertoquini S, Ribau V, Teixeira M, et al.: Effect of exercise training on ambulatory blood pressure among patients with resistant hypertension: A randomized clinical trial. JAMA Cardiol 6: 13171323, 2021 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    De la Sierra A, Banegas JR, Oliveras A, Gorostidi M, Segura J, de la Cruz JJ, et al.: Clinical differences between resistant hypertensives and patients treated and controlled with three or less drugs. J Hypertens 30: 12111216, 2012 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    De la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Armario P, et al.: Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension 57: 898902, 2011 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Cohen JB, Lotito MJ, Trivedi UK, Denker MG, Cohen DL, Townsend RR: Cardiovascular events and mortality in white coat hypertension: A systematic review and meta-analysis. Ann Intern Med 170: 853862, 2019 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Hundemer GL, Kline GA, Leung AA: How common is primary aldosteronism? Curr Opin Nephrol Hypertens 30: 353360, 2021 PubMed

  • 21

    Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al.: The management of primary aldosteronism: Case detection, diagnosis, and treatment: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 101: 18891916, 2016 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Hundemer GL, Baudrand R, Brown JM, Curhan G, Williams GH, Vaidya A: Renin phenotypes characterize vascular disease, autonomous aldosteronism, and mineralocorticoid receptor activity. J Clin Endocrinol Metab 102: 18351843, 2017 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Vasan RS, Evans JC, Larson MG, Wilson PW, Meigs JB, Rifai N, et al.: Serum aldosterone and the incidence of hypertension in nonhypertensive persons. N Engl J Med 351: 3341, 2004 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Newton-Cheh C, Guo CY, Gona P, Larson MG, Benjamin EJ, Wang TJ, et al.: Clinical and genetic correlates of aldosterone-to-renin ratio and relations to blood pressure in a community sample. Hypertension 49: 846856, 2007 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Kim SK, McCurley AT, DuPont JJ, Aronovitz M, Moss ME, Stillman IE, et al.: Smooth muscle cell-mineralocorticoid receptor as a mediator of cardiovascular stiffness with aging. Hypertension 71: 609621, 2018 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Monticone S, D’Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, et al.: Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: A systematic review and meta-analysis. Lancet Diabetes Endocrinol 6: 4150, 2018 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Arlt W, Lang K, Sitch AJ, Dietz AS, Rhayem Y, Bancos I, et al.: Steroid metabolome analysis reveals prevalent glucocorticoid excess in primary aldosteronism. JCI Insight 2: e93136, 2017 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Monticone S, Sconfienza E, D’Ascenzo F, Buffolo F, Satoh F, Sechi LA, et al.: Renal damage in primary aldosteronism: A systematic review and meta-analysis. J Hypertens 38: 312, 2020 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Cohen JB, Cohen DL, Herman DS, Leppert JT, Byrd JB, Bhalla V: Testing for primary aldosteronism and mineralocorticoid receptor antagonist use among U.S. veterans: A retrospective cohort study. Ann Intern Med 174: 289297, 2021 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Hundemer GL, Imsirovic H, Vaidya A, Yozamp N, Goupil R, Madore F, et al.: Screening rates for primary aldosteronism among individuals with hypertension plus hypokalemia: A population-based retrospective cohort study. Hypertension 79: 178186, 2021 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31

    Hundemer GL, Vaidya A: Primary aldosteronism diagnosis and management: A clinical approach. Endocrinol Metab Clin North Am 48: 681700, 2019 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32

    Hung A, Ahmed S, Gupta A, Davis A, Kline GA, Leung AA, et al.: Performance of the aldosterone-to-renin ratio as a screening test for primary aldosteronism: A systematic review and meta-analysis. J Clin Endocrinol Metab 106: 24232435, 2021

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Kempers MJ, Lenders JW, van Outheusden L, van der Wilt GJ, Schultze Kool LJ, Hermus AR, et al.: Systematic review: Diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med 151: 329337, 2009 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34

    Williams TA, Lenders JWM, Mulatero P, Burrello J, Rottenkolber M, Adolf C, et al.; Primary Aldosteronism Surgery Outcome (PASO) investigators: Outcomes after adrenalectomy for unilateral primary aldosteronism: An international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol 5: 689699, 2017 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35

    Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A: Renal outcomes in medically and surgically treated primary aldosteronism. Hypertension 72: 658666, 2018 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36

    Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A: Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: A retrospective cohort study. Lancet Diabetes Endocrinol 6: 5159, 2018 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37

    Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A: Incidence of atrial fibrillation and mineralocorticoid receptor activity in patients with medically and surgically treated primary aldosteronism. JAMA Cardiol 3: 768774, 2018 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38

    Köhler A, Sarkis AL, Heinrich DA, Müller L, Handgriff L, Deniz S, et al.: Renin, a marker for left ventricular hypertrophy, in primary aldosteronism: A cohort study. Eur J Endocrinol 185: 663672, 2021 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 39

    Baudrand R, Guarda FJ, Torrey J, Williams G, Vaidya A: Dietary sodium restriction increases the risk of misinterpreting mild cases of primary aldosteronism. J Clin Endocrinol Metab 101: 39893996, 2016 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40

    Lerman LO, Textor SC, Grande JP: Mechanisms of tissue injury in renal artery stenosis: Ischemia and beyond. Prog Cardiovasc Dis 52: 196203, 2009 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41

    De Bruyne B, Manoharan G, Pijls NH, Verhamme K, Madaric J, Bartunek J, et al.: Assessment of renal artery stenosis severity by pressure gradient measurements. J Am Coll Cardiol 48: 18511855, 2006 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42

    Drieghe B, Madaric J, Sarno G, Manoharan G, Bartunek J, Heyndrickx GR, et al.: Assessment of renal artery stenosis: Side-by-side comparison of angiography and duplex ultrasound with pressure gradient measurements. Eur Heart J 29: 517524, 2008 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43

    Herrmann SM, Textor SC: Renovascular hypertension. Endocrinol Metab Clin North Am 48: 765778, 2019 PubMed

  • 44

    Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH, et al.: The United States Registry for Fibromuscular Dysplasia: Results in the first 447 patients. Circulation 125: 31823190, 2012 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45

    Herrmann SM, Textor SC: Current concepts in the treatment of renovascular hypertension. Am J Hypertens 31: 139149, 2018 PubMed

  • 46

    Cooper CJ, Murphy TP, Cutlip DE, Jamerson K, Henrich W, Reid DM, et al.; CORAL Investigators: Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med 370: 1322, 2014 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47

    Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, Baigent C, et al.; ASTRAL Investigators: Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med 361: 19531962, 2009 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 48

    Bax L, Woittiez AJ, Kouwenberg HJ, Mali WPTM. Buskens E. Beek FJA et al.: Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: A randomized trial. Ann Intern Med 150: 840848, 2009 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49

    Hackam DG, Duong-Hua ML, Mamdani M, Li P, Tobe SW, Spence JD, et al.: Angiotensin inhibition in renovascular disease: A population-based cohort study. Am Heart J 156: 549555, 2008 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50

    Parikh SA, Shishehbor MH, Gray BH, White CJ, Jaff MR: SCAI expert consensus statement for renal artery stenting appropriate use. Catheter Cardiovasc Interv 84: 11631171, 2014 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51

    Stone PA, Campbell JE, Aburahma AF, Hamdan M, Broce M, Nanjundappa A, et al.: Ten-year experience with renal artery in-stent stenosis. J Vasc Surg 53: 10261031, 2011 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 52

    Trinquart L, Mounier-Vehier C, Sapoval M, Gagnon N, Plouin PF: Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: A systematic review and meta-analysis. Hypertension 56: 525532, 2010 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 53

    Lenders JW, Duh QY, Eisenhofer G, Gimenez-Roqueplo AP, Grebe SK, Murad MH, et al.; Endocrine Society: Pheochromocytoma and paraganglioma: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 99: 19151942, 2014 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54

    Gruber LM, Hartman RP, Thompson GB, McKenzie TJ, Lyden ML, Dy BM, et al.: Pheochromocytoma characteristics and behavior differ depending on method of discovery. J Clin Endocrinol Metab 104: 13861393, 2019 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 55

    Stolk RF, Bakx C, Mulder J, Timmers HJ, Lenders JW: Is the excess cardiovascular morbidity in pheochromocytoma related to blood pressure or to catecholamines? J Clin Endocrinol Metab 98: 11001106, 2013 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 56

    Muntner P, Anderson A, Charleston J, Chen Z, Ford V, Makos G, et al.; Chronic Renal Insufficiency Cohort (CRIC) Study Investigators: Hypertension awareness, treatment, and control in adults with CKD: Results from the chronic renal insufficiency cohort (CRIC) study. Am J Kidney Dis 55: 441451, 2010 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 57

    De Nicola L, Gabbai FB, Agarwal R, Chiodini P, Borrelli S, Bellizzi V, et al.: Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients. J Am Coll Cardiol 61: 24612467, 2013 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 58

    Muntner P, He J, Hamm L, Loria C, Whelton PK: Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 13: 745753, 2002 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 59

    Lee S, Oh HJ, Lee EK, Lee O, Ha E, Kim SJ, et al.: Blood pressure control during chronic kidney disease progression. Am J Hypertens 30: 610616, 2017 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 60

    Gonçalves SC, Martinez D, Gus M, de Abreu-Silva EO, Bertoluci C, Dutra I, et al.: Obstructive sleep apnea and resistant hypertension: A case-control study. Chest 132: 18581862, 2007 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 61

    Chee MR, Hoo J, Libianto R, Gwini SM, Hamilton G, Narayan O, et al.: Prospective screening for primary aldosteronism in patients with suspected obstructive sleep apnea. Hypertension 77: 20942103, 2021 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 62

    Pratt-Ubunama MN, Nishizaka MK, Boedefeld RL, Cofield SS, Harding SM, Calhoun DA: Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension. Chest 131: 453459, 2007 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 63

    Yang L, Zhang H, Cai M, Zou Y, Jiang X, Song L, et al.: Effect of spironolactone on patients with resistant hypertension and obstructive sleep apnea. Clin Exp Hypertens 38: 464468, 2016 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 64

    Bratton DJ, Gaisl T, Wons AM, Kohler M: CPAP vs mandibular advancement devices and blood pressure in patients with obstructive sleep apnea: A systematic review and meta-analysis. JAMA 314: 22802293, 2015 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 65

    McEvoy RD, Antic NA, Heeley E, Luo Y, Ou Q, Zhang X, et al.; SAVE Investigators and Coordinators: CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med 375: 919931, 2016 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 66

    Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, et al.: 2018 AHA/ACC guideline for the management of adults with congenital heart disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol 73: e81e192, 2019 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 67

    Johnson AG, Nguyen TV, Day RO: Do nonsteroidal anti-inflammatory drugs affect blood pressure? A meta-analysis. Ann Intern Med 121: 289300, 1994 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 68

    Chasan-Taber L, Willett WC, Manson JE, Spiegelman D, Hunter DJ, Curhan G, et al.: Prospective study of oral contraceptives and hypertension among women in the United States. Circulation 94: 483489, 1996 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 69

    Abdel-Qadir H, Ethier JL, Lee DS, Thavendiranathan P, Amir E: Cardiovascular toxicity of angiogenesis inhibitors in treatment of malignancy: A systematic review and meta-analysis. Cancer Treat Rev 53: 120127, 2017 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 70

    Mir O, Ropert S, Alexandre J, Goldwasser F: Hypertension as a surrogate marker for the activity of anti-VEGF agents. Ann Oncol 20: 967970, 2009 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 71

    Valassi E, Santos A, Yaneva M, Tóth M, Strasburger CJ, Chanson P, et al.; ERCUSYN Study Group: The European Registry on Cushing’s syndrome: 2-year experience. Baseline demographic and clinical characteristics. Eur J Endocrinol 165: 383392, 2011 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 72

    Nieman LK: Hypertension and cardiovascular mortality in patients with Cushing syndrome. Endocrinol Metab Clin North Am 48: 717725, 2019 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 73

    Agarwal R, Sinha AD, Cramer AE, Balmes-Fenwick M, Dickinson JH, Ouyang F, et al.: Chlorthalidone for hypertension in advanced chronic kidney disease. N Engl J Med 385: 25072519, 2021 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 74

    Williams B, MacDonald TM, Morant S, Webb DJ, Sever P, McInnes G, et al.; British Hypertension Society’s PATHWAY Studies Group: Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): A randomised, double-blind, crossover trial. Lancet 386: 20592068, 2015 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 75

    Williams B, MacDonald TM, Morant SV, Webb DJ, Sever P, McInnes GT, et al.; British Hypertension Society programme of Prevention And Treatment of Hypertension With Algorithm based Therapy (PATHWAY) Study Group: Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: The PATHWAY-2 mechanisms substudies. Lancet Diabetes Endocrinol 6: 464475, 2018 PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 495 495 202
Full Text Views 409 409 75
PDF Downloads 540 540 108