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Spironolactone Reduces Blood Pressure in Patients with Resistant Hypertension

Low-dose spironolactone significantly reduces blood pressure (BP) when added to antihypertensive treatment in subjects with resistant hypertension with and without primary aldosteronism, new research suggests.

Previous reports have demonstrated the efficacy of high doses of spironolactone in subjects with primary aldosteronism and/or resistant hypertension.

In their analysis, Mari Konishi Nishizaka, MD, with the University of Alabama at Birmingham, United States, and colleagues examined the antihypertensive benefit of low-dose spironolactone added to multidrug regimens that included a diuretic and an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB).

Seventy six subjects with resistant hypertension were included in the analysis, 34 of whom had biochemical primary aldosteronism.

The diagnosis of primary aldosteronism was confirmed with a renin activity <1.0 ng/mL/h, urinary aldosterone >12 mug/24 h and urinary sodium >200 mEq/24 h.

After biochemical evaluation, spironolactone (12.5 to 25 mg/d) was administered while the subjects continued to take other antihypertensives. If BP remained uncontrolled, the dose of spironolactone was titrated up to 50 mg/d.

BP was determined at 6 weeks, 3 months, and 6 months. Low-dose spironolactone was associated with an additional mean decrease in BP of 21/10 mmHg at 6 weeks and 25/12 mmHg at 6-month follow-up.

According to the researchers, BP reduction was similar in subjects with and without primary aldosteronism and was additive to the use of ACE inhibitors, ARBs, and diuretics.

A previous study indicated that combined therapy with an ACE inhibitor and spironolactone could cause hyperkalemia, especially among the elderly or those with chronic kidney disease, the researchers point out. In their study, 2 subjects developed hyperkalemia, and both were receiving an ACE inhibitor and had chronic kidney disease, they note.

"This is the first report to demonstrate that low doses of spironolactone can induce substantial BP reduction when added to multidrug regimens that include ACE inhibitors and/or ARBs and diuretics," they write.

"The current observations may be relevant to clinicians treating patients with hypertension that remains resistant to multidrug regimens," they conclude.





Am J Hypertens 2003;16:11:925-930. "Efficacy of low-dose spironolactone in subjects with resistant hypertension"

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