What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=2090). Intervention: Spironolactone vs. Antihypertensive regimen without spironolactone. Primary outcome: Systolic blood pressure (mmHg) in African American females (p=<0.05).

May 9, 2019Open Access

Sex-specific responses to mineralocorticoid receptor antagonism in hypertensive African American males and females

Q: What are the key findings of this study?

In hypertensive African American women, spironolactone use was associated with significantly lower systolic blood pressure (122 vs 139 mmHg) and a lower proportion of uncontrolled hypertension (0% vs 46%) compared to other regimens.

Key Result

In hypertensive African American women, spironolactone use was associated with significantly lower systolic blood pressure (122 vs 139 mmHg) and a lower proportion of uncontrolled hypertension (0% vs 46%) compared to other regimens.

Study Design

Type

Cross-Sectional (n=2,090)

Multicenter

Yes

Structured PICO

Does spironolactone improve blood pressure control in hypertensive African American males and females?

Population

2,167 adults from the GENOA study, including 1,483 African American individuals (males and females) and 684 white females, with and without hypertension. Excluded patients with evidence of heart failure (ejection fraction ≤40%).

Intervention

Spironolactone (mineralocorticoid receptor antagonist) included in the oral antihypertensive regimen.

Comparator

Hypertensive patients not taking spironolactone (receiving other antihypertensive medications).

Outcome

Systolic and diastolic blood pressure, and proportion of uncontrolled hypertension (SBP ≥140 or DBP ≥90 mmHg) at a single cross-sectional time point.surrogate

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.

Main Result

Absolute Event Rate: 122% vs 139%

p-value: p=<0.05

Limitations

Low number of patients taking spironolactone (n=9 for African American females)
Cross-sectional design with data collected at a single time point
Patient's status before antihypertensive therapy is unknown
Duration, dosage, and frequency of spironolactone use were not reported
White females on spironolactone had no echocardiography data to confirm the absence of heart failure

Abstract

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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