# Spironolacton versus clonidine als vierde middel bij resistente hypertensie: ReHOT

*geplaatst 2018-04-01 · Hypertensie · Hypertension (Dallas, Tex. : 1979) · doi 10.1161/HYPERTENSIONAHA.117.10662 · https://hartvaat.nl/2018/04/01/spironolacton-versus-clonidine-als-vierde-middel-bij-resistente-hypertensie-reho/*

ReHOT gerandomiseerde trial die spironolacton vergeleek met clonidine als vierdelijns antihypertensivum bij resistente hypertensie. Bevestigt de voorkeurspositie van spironolacton.

## English: Spironolactone Versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension: The ReHOT Randomized Study (Resistant Hypertension Optimal Treatment).

The ReHOT trial compared spironolactone with clonidine as fourth-line therapy for resistant hypertension, finding that spironolactone achieved better ambulatory blood pressure control. The result supported spironolactone as the preferred add-on agent.

## Abstract (original, from the publication)

UNLABELLED: The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55-1.88]; P=1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01643434.

Auteurs: Eduardo M Krieger, Luciano F Drager, Dante M A Giorgi, Alexandre C Pereira, José Augusto Soares Barreto-Filho, Armando R Nogueira, José Geraldo Mill, Paulo A Lotufo, Celso Amodeo, Marcelo C Batista, Luiz C Bodanese, Antônio C C Carvalho, Iran Castro, Hilton Chaves, Eduardo A S Costa, Gilson S Feitosa, Roberto J S Franco, Flávio D Fuchs, Armênio C Guimarães, Paulo C Jardim, Carlos A Machado, Maria E Magalhães, Décio Mion, Raimundo M Nascimento, Fernando Nobre, Antônio C Nóbrega, Antônio L P Ribeiro, Carlos R Rodrigues-Sobrinho, Antônio F Sanjuliani, Maria do Carmo B Teixeira, Jose E Krieger

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Bron: Hypertension (Dallas, Tex. : 1979), https://doi.org/10.1161/HYPERTENSIONAHA.117.10662. Bijgewerkt 2026-07-03T13:26:28Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.