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[Correspondence] PATHWAY-2: spironolactone for resistant hypertension – Authors’ reply

We thank Boutari and colleagues, Gkaliagkousi and colleagues, and Dale and colleagues for their interest in our findings in the PATHWAY-2 study.1 As noted at the end of our Research in context, we also believe that there might be substantial overlap between primary aldosteronism and resistant hypertension. Plasma aldosterone, measured in our substudy was not predictive on its own of blood pressure response (unpublished). However, PATHWAY-2 shows that in patients receiving treatment with three drugs (angiotensin-converting-enzyme inhibitor or an angiotensin II receptor blocker, plus a calcium channel blocker, plus a thiazide-like diuretic—ie, A + C + D) at baseline, plasma renin values in the lower third of the normal range are inappropriately low and might be the sole clue to underlying primary aldosteronism.

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