Sequential nephron blockade vs. sequential renin-angiotensin system blockade on central and ambulatory blood pressure in resistant hypertension: A randomized clinical trial.

AIMS: This study compares sequential nephron blockade (SNB) and renin-angiotensin system sequential blockade (RASSB) in patients with resistant hypertension (RHTN), evaluating central systolic pressure, arterial stiffness, pulse pressure and ambulatory blood pressure monitoring (ABPM).

METHODS

A total of 72 patients with resistant hypertension were recruited from the Hypertension Outpatient Clinic and randomly allocated to two treatment groups: SNB (n = 35; 22 women, 13 men) and RASSB (n = 37; 22 women, 15 men). Central systolic blood pressure (CSBP), augmentation index (AI) and AI75 were assessed using validated non-invasive tonometry. ABPM was performed over 24 h to evaluate systolic, diastolic and pulse pressure changes.

RESULTS

Office blood pressure reductions were significant in both groups (p < .0001). SNB: SBP from 174.5 to 127.0 mmHg; DBP from 105.3 to 78.11 mmHg.

RASSB: SBP from 178.4 to 134.4 mmHg; DBP from 102.7 to 77.33 mmHg. ABPM confirmed 24-h reductions (p < .0001). SNB showed greater pulse pressure reduction (Δ = 22.99 vs. 15.93 mmHg, p = .024) and central systolic pressure reduction (Δ = -10.3 vs. -5.1 mmHg, p = .036). RASSB elicited a significant decrease in heart rate (Δ = -12.4 bpm, p < .0001). No treatment-related discontinuations occurred.

CONCLUSION

SNB demonstrated superior efficacy in reducing CSBP and pulse pressure, while RASSB more effectively lowered heart rate. These distinct haemodynamic responses support individualized treatment strategies for patients with RHTN.