On 2016 Feb 23, NephJC - Nephrology Journal Club commented:

This trial was discussed on Oct 27th and 28th in the open online nephrology journal club, #NephJC, on twitter. Introductory comments by Paul Phelan are available at the NephJC website, along with a primer on spironolactone by Joel Topf on the NephJC blog. The discussion was quite detailed, with more than 70 participants, including nephrologists, fellows, residents and patients. A transcript and a curated (Storify) version of the tweetchat are available from the NephJC website. The highlights of the tweetchat were:

• The authors should be commended for designing and conducting and the british Heart Foundation and National Institute for Health Research for funding this trial.

• This was a very well designed and conducted trial, with good selection of population (hypertension not at target despite three frontline agents (ACE-inhibitors or ARB, calcium channel blockers and a thiazide diuretic) and meticulous assessment of non-adherence, including direct observed therapy. Minor weaknesses brought up included the use of office and home blood pressure measurement rather than ambulatory monitoring, and the lack of washout between the crossover phases.

• This trial does establish spironolactone as the drug of choice for reducing blood pressure patients with uncontrolled hypertension despite the three frontline agents. However, the discussion did raise the cautionary tale of a rise in hyperkalemia admissions after the RALES trial. There is a need to be careful with generalizability as spironolactone gets used less judiciously and with less monitoring than would happen in a clinical trial.

Interested individuals can track and join in the conversation by following @NephJC, #NephJC, signing up for the mailing list, or visit the webpage at NephJC.com.

On 2016 Feb 23, NephJC - Nephrology Journal Club commented:

This trial was discussed on Oct 27th and 28th in the open online nephrology journal club, #NephJC, on twitter. Introductory comments by Paul Phelan are available at the NephJC website, along with a primer on spironolactone by Joel Topf on the NephJC blog. The discussion was quite detailed, with more than 70 participants, including nephrologists, fellows, residents and patients. A transcript and a curated (Storify) version of the tweetchat are available from the NephJC website. The highlights of the tweetchat were:

• The authors should be commended for designing and conducting and the british Heart Foundation and National Institute for Health Research for funding this trial.

• This was a very well designed and conducted trial, with good selection of population (hypertension not at target despite three frontline agents (ACE-inhibitors or ARB, calcium channel blockers and a thiazide diuretic) and meticulous assessment of non-adherence, including direct observed therapy. Minor weaknesses brought up included the use of office and home blood pressure measurement rather than ambulatory monitoring, and the lack of washout between the crossover phases.

• This trial does establish spironolactone as the drug of choice for reducing blood pressure patients with uncontrolled hypertension despite the three frontline agents. However, the discussion did raise the cautionary tale of a rise in hyperkalemia admissions after the RALES trial. There is a need to be careful with generalizability as spironolactone gets used less judiciously and with less monitoring than would happen in a clinical trial.

Interested individuals can track and join in the conversation by following @NephJC, #NephJC, signing up for the mailing list, or visit the webpage at NephJC.com.