Key result
In hypertensive African American women, spironolactone use was associated with lower systolic blood pressure (122 vs 139 mmHg) and a lower proportion of uncontrolled hypertension compared to other regimens.
Why the study?
Mineralocorticoid antagonists effectively treat uncontrolled hypertension in African American and white patients, but sex-specific responses remain unclear.
Does spironolactone improve blood pressure control in hypertensive African American males and females?
Cross-Sectional (n=2,090)
Yes
Does spironolactone improve blood pressure control in hypertensive African American males and females?
Spironolactone may be particularly effective in reducing blood pressure and controlling hypertension in African American women, though larger prospective studies are needed to confirm this sex-specific benefit.
Answers are grounded in this paper and cite their sources.
Spironolactone may aid BP control in hypertensive African American women; hypothesis-generating and leaves open prospective confirmation including men.
BACKGROUND: African Americans (AA) develop hypertension (HTN) at an earlier age, have a greater frequency and severity of HTN, and greater prevalence of uncontrolled HTN as compared to the white population. Mineralocorticoid antagonists have been shown to be very effective in treating uncontrolled HTN in both AA and white patients, but sex-specific responses are unclear. METHODS: We evaluated the sex-specific impact of mineralocorticoid antagonism in an AA population. An AA cohort (n = 1483) from the Genetic Epidemiology Network of Arteriopathy study was stratified based on sex and whether they were taking spironolactone, a mineralocorticoid antagonist, in their antihypertensive regimen. RESULTS: As compared to AA women not prescribed a mineralocorticoid antagonist, AA women taking spironolactone (n = 9) had lower systolic and diastolic blood pressure despite having a similar number of antihypertensive medications. The proportion of AA women with uncontrolled HTN was significantly less for patients taking spironolactone than for patients not prescribed spironolactone. Interestingly, none of these associations were found in the AA males or in white females. CONCLUSIONS: Our data suggests that spironolactone is particularly effective in reducing blood pressure and controlling HTN in AA women. Further research into the impact of this therapy in this underserved and understudied minority is warranted.
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Clemmer et al. (2019) conducted a cross-sectional in Hypertension (n=2,090). Spironolactone vs. Antihypertensive regimen without spironolactone was evaluated on Systolic blood pressure (mmHg) in African American females (p=<0.05). In hypertensive African American women, spironolactone use was associated with lower systolic blood pressure (122 vs 139 mmHg) and a lower proportion of uncontrolled hypertension compared to other regimens.
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