The role of spironolactone in the treatment of patients with refractory hypertension

• Published in: American journal of hypertension Vol. 15; no. 4; pp. 333 - 339
• Main Authors: Ouzan, James, Pérault, Catherine, Lincoff, A.Michael, Carré, Evelyne, Mertes, Michel
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2002; Oxford University Press; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Aldosterone - blood; ambulatory blood pressure monitoring; Antihypertensive agents; Biological and medical sciences; Blood Pressure - drug effects; Cardiovascular system; Female; Humans; Hypertension - blood; Hypertension - drug therapy; Hypertension - physiopathology; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prospective Studies; Refractory hypertension; Renin - blood; spironolactone; Spironolactone - therapeutic use; ambulatory blood pressure monitoring; Refractory hypertension; spironolactone; Human; Hypertension; Potassium sparing diuretic; Toxicity; Treatment efficiency; Cardiovascular disease; Refractory; Aldosterone antagonist; Chemotherapy; Treatment; Spironolactone; Antihypertensive agent; Combined treatment
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/S0895-7061(01)02342-1

Hypertension is resistant to pharmacologic therapy in 5% to 10% of patients. The current study tested whether addition of spironolactone to the treatment of patients with refractory hypertension would lead to adequate blood pressure (BP) control. Among 520 patients who were referred for treatment of hypertension to one medical clinic from 1997 to 1999, a total of 25 patients who met the inclusion criteria of refractory hypertension were prospectively included in this study. The inclusion criteria were as follows: 1) hypertension of ≥6 months without any apparent cause; 2) clinical BP measurement and mean 24-h ambulatory BP monitoring >140/90 mm Hg despite treatment with at least two antihypertensive drugs; 3) no prior therapy with spironolactone; and 4) no renal insufficiency. Spironolactone was added to the previous regimen at a dosage of 1 mg/kg/day while any angiotensin converting enzyme inhibitor was suppressed. Serum potassium and creatinine levels were checked before the introduction of spironolactone and 1 month later. After 1 month of therapy with spironolactone, 23 patients had a clinical BP <140/90 mm Hg. Ambulatory BP monitoring when compared before and 1 month after initiation of spironolactone decreased significantly (systolic BP from 152 ± 2 mm Hg to 128 ± 2 mm Hg, P < .001; and diastolic BP from 86 ± 2 mm Hg to 76 ± 2 mm Hg, P < .013). By 3 months after the introduction of spironolactone, the mean number of antihypertensive drugs required per patient was significantly reduced (from 3.2 ± 0.2 to 2.1 ± 0.2, P < .001). No patient required discontinuation of spironolactone due to adverse renal effects. Spironolactone is a safe, effective therapy for patients with refractory hypertension.