Age

18–80

Sex

ALL

Healthy volunteers

Accepted

Participants will be selected from a broad range of medical clinics at the Salt Lake City VA Medical Center and surrounding community based outpatient clinics (CBOCs).
The participants will be referred to a resistant hypertension clinic by either their primary care provider or by a subspecialist. The referrals are made via a computerized system that is used in the Veterans Affairs Medical Center (VA) called Computerized Patient Record System (CPRS).
Patients are referred if their blood pressure is above goal as defined by JNC 7 and they are on 3 antihypertensive medications with one of the agents being a diuretic.
All patients age 18 -80 years old.

Patients that will be excluded from the study if they have had a documented adverse reaction to either spironolactone or amiloride.
diagnosis of primary hyperaldosteronism
inability to adhere to frequent laboratory monitoring
estimated glomerular filtration rate (GFR) \< 45 ml/min/1.73m2
baseline serum potassium above 5.0 mEq/L
type 4 renal tubular acidosis
pregnancy
heart failure that meets criteria for using either eplerenone or spironolactone
current unstable renal function

Spironolactone Versus Amiloride as an Add on Agent in Resistant Hypertension