▲ Professor Dae-Hee Kim and his team from the Division of Cardiology at Asan Medical Center 

Resistant hypertension is a condition in which blood pressure remains above target levels despite the use of three or more antihypertensive medications. It carries a 1.5 to 2 times higher risk of cardiovascular disease compared to general hypertension, which requires proactive management. While treatment guidelines recommend spironolactone as a fourth-line treatment, it has been used with caution in clinical settings due to potential side effects such as impaired kidney function, gynecomastia, and amenorrhea.

Professor Dae-Hee Kim and his team from the Division of Cardiology at Asan Medical Center recently published a study that first demonstrate the strong antihypertensive effect of amiloride as a fourth-line treatment for hypertension. Amiloride is a potassium-sparing diuretic similar to spironolactone. The research team enrolled 118 patients with resistant hypertension across 14 tertiary hospitals in Korea, who were randomly assigned to either an amiloride group (58 patients) or a spironolactone group (60 patients) for 12 weeks of treatment. Results showed that home-measured systolic blood pressure decreased by an average of 14.7 mmHg in the amiloride group and 13.6 mmHg in the spironolactone group, with no significant difference between the two. In addition, the proportion of patients achieving normal systolic blood pressure at home (130 mmHg or below) was 66.1% in the amiloride group and 55.2% in the spironolactone group. In clinical settings, 57.1% of the amiloride group and 60.3% of the spironolactone group achieved target systolic levels, again with no significant difference between the two groups.

Professor Dae-Hee Kim stated, “This study is the first to demonstrate the therapeutic potential of amiloride, which shows a blood pressure-lowering effect similar to that of the currently recommended drug spironolactone. We expect that amiloride could become a promising treatment alternative for patients who are at risk of experiencing significant side effects.”

The findings of this study were recently published in ‘JAMA’ (Journal of the American Medical Association), a leading international medical journal published by the American Medical Association.