Williams B, et al. - Given spironolactone brought about more substantial reduction of blood pressure as compared with conventional antihypertensive drugs in the PATHWAY-2 study of resistant hypertension (a randomised, double-blind crossover trial done at 14 UK primary and secondary care sites), researchers performed three substudies to evaluate the mechanisms underlying this superiority and the pathogenesis of resistant hypertension. They acknowledged that inappropriate aldosterone secretion most likely accounts for resistant hypertension, which commonly represents a salt-retaining state. They found that spironolactone-induced mineralocorticoid receptor blockade overcomes the salt retention and resistance of hypertension to treatment. Antihypertensive efficacy of amiloride seemed to be equal to that of spironolactone and hence, it can serve as a substitute treatment for resistant hypertension.