Professor Daniel Piskorz

Urine Haptoglobin and Haptoglobin-Related Protein Predict Response to Spironolactone in Patients with Resistant Hypertension

Marta Martin-Lorenzo, Paula J. Martinez, Montserrat Baldan-Martin, Juan A. Lopez, Pablo Minguez, Aranzazu Santiago-Hernandez, Jesus Vazquez, Julián Segura, Gema Ruiz-Hurtado, Fernando Vivanco, Maria G. Barderas, Luis M. Ruilope, Gloria Alvarez-Llamas.

Hypertension. 2019; 73: 00-00. DOI: 10.1161/HYPERTENSIONAHA.118.12242.

Why I selected this manuscript?
Resistant hypertension double the risk of end stage renal disease, increase by almost 60 % the risk of stroke and 45 % of coronary artery disease, and enhance by approximately 30 % the mortality (Muntner P. Hypertension 2014; 64: 1012 – 1021.).  The hazard ratio is independent of age, sex, other risk factors, metabolic disorders or co-morbidities (Hung CY. PLoS ONE 2014; 9: e104362). Hemodynamic management at specialized centers resulted in 33 % improved control rates (Taler S. Hypertension 2002; 39: 982 – 988); Baroreflex Activation Therapy reduced significantly blood pressure at six months but not at 12 months (Bisognano JD. J Am Coll Cardiol 2011; 58: 765 – 773); Renal Denervation showed a not significant reduction of -1.32 (95 % CI, -4.50 to 1.85 P= 0.41) in home systolic blood pressure (Bhatt DL. N Engl J Med 2014; 370: 1393 – 1401; Bakris G. J Am Coll Cardiol 2014; 64: 1071 – 1078); and although the PATHWAY-2 trial demonstrated a significant blood pressure reduction with spironolactone, still a 42 % of patients remained uncontrolled (Williams B. Lancet2015; 386: 2059 – 2068). The paper by Martín-Lorenzo et al called my attention because contributes to optimize the unresolved management in a niche of high blood pressure patients, those with resistant hypertension. The researchers found that urine protein changes could predict the blood pressure response to spironolactone treatment in resistant hypertension patients. Haptoglobin (HP) and Haptoglobin-related protein (HPR) in urine could distinguished between patients with resistant hypertension who respond to spironolactone and non-responder patients. ELISA assays were performed for absolute protein quantitation finding 163.6±146.3 μg HP/g creatinine and 8.5±6.6 μg HPR/g creatinine for resistant hypertension responders and 430.4±387.7 μg HP/g creatinine and 34.5±35.5 μg HPR/g creatinine for resistant hypertension non-responders  (P=0.0046 for HP and P=0.0051 for HPR). The receiver operating characteristics curves were 0.74 for HP and 0.67 for HPR.