Key result
Spironolactone resulted in lower average 24-hour and nocturnal systolic blood pressure compared to hydrochlorothiazide at 6 months (P<0.001), while both comparably reduced vascular stiffness.
Why the study?
Does spironolactone improve blood pressure control and vascular stiffness compared to hydrochlorothiazide in older patients with hypertension?
RCT (n=45)
Double-blind
Randomized
No
Does spironolactone improve blood pressure control and vascular stiffness compared to hydrochlorothiazide in older patients with hypertension?
p-value: p=<.001
Spironolactone and hydrochlorothiazide monotherapy both effectively reduce blood pressure and vascular stiffness in older hypertensive patients, with spironolactone showing greater reduction in 24-hour and nocturnal SBP.
Spironolactone may be preferred over hydrochlorothiazide for 24-hour BP control in older hypertensives; extends RCT evidence on ambulatory effects versus thiazides.
OBJECTIVES: To determine the efficacy of spironolactone (SPIRO) and hydrochlorothiazide (HCTZ) as monotherapy in older patients with hypertension in blood pressure (BP) control and measures of vascular stiffness. DESIGN: Randomized double-blind trial. SETTING: University teaching hospital. PARTICIPANTS: Forty-five subjects with hypertension (24 men, 21 women, mean age 69). INTERVENTION: Six months of HCTZ (n=21) or SPIRO (n=24) therapy titrated to a target systolic BP (SBP) less than 140 mmHg. MEASUREMENTS: Baseline (after 4 weeks of antihypertensive drug washout) and 6-month 24-hour ambulatory BP data were obtained. Pulse pressure (PP) was calculated as the difference between 24-hour average SBP and DBP. Pulse wave velocity (PWV) was determined according to noninvasive recordings of carotid and femoral artery pulse waves. RESULTS: Six months of HCTZ and SPIRO treatment was associated with significant decreases in 24-hour and nocturnal SBP and diastolic BP (DBP) (analysis of variance (ANOVA) P<.001). At 6 months, average 24-hour and nocturnal SBP were lower in the SPIRO than the HCTZ group (P<.001). PP and PWV also decreased significantly with HCTZ and SPIRO treatments (ANOVA P<.001). CONCLUSIONS: Six months of therapy with HCTZ or SPIRO resulted in comparable reductions in 24-hour average and nocturnal SBP and DBP, PP, and PWV in older subjects with hypertension.
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Kithas et al. (2010) conducted an RCT in hypertension (n=45). Spironolactone vs. Hydrochlorothiazide was evaluated on 24-hour and nocturnal SBP and DBP, pulse pressure, and pulse wave velocity (p=<.001). Spironolactone resulted in lower average 24-hour and nocturnal systolic blood pressure compared to hydrochlorothiazide at 6 months (P<0.001), while both comparably reduced vascular stiffness.
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