Key result
Spironolactone significantly reduced sympathetic nervous system activity (plasma NE P=0.04) and blood pressure in older hypertensive patients, whereas hydrochlorothiazide did not.
Why the study?
Does spironolactone reduce sympathetic nervous system activity and blood pressure compared to hydrochlorothiazide in older patients with stage 1 hypertension?
RCT (n=36)
Double-blind
randomized
Does spironolactone reduce sympathetic nervous system activity and blood pressure compared to hydrochlorothiazide in older patients with stage 1 hypertension?
p-value: p=0.04
In older patients with stage 1 hypertension, spironolactone significantly reduces sympathetic nervous system activity compared to hydrochlorothiazide, despite both agents effectively lowering blood pressure.
Spironolactone may be prioritized over hydrochlorothiazide in older hypertension for sympathetic suppression; extends evidence on differential autonomic effects.
Aldosterone receptor blockade and thiazide therapy effectively lower blood pressure in geriatric hypertension. Their impact on sympathetic nervous system function has not been evaluated. In a double-blind, randomized study, 36 patients with stage 1 hypertension underwent 6 months of therapy with either aldosterone receptor blockade (spironolactone, n=19; 68+/-1 years) or hydrochlorothiazide (n=17; 68+/-2 years). Arterial blood pressure, [(3)H]-norepinephrine (NE) kinetics (extravascular NE release rate), and alpha-adrenergic responsiveness (forearm vasoconstriction to graded intrabrachial artery NE infusions) were evaluated at baseline, after a 4-week antihypertensive medication withdrawal, and after spironolactone or hydrochlorothiazide treatment. Arterial blood pressure decreased significantly with both spironolactone (160+/-3 to 134+/-2 mm Hg; 77+/-2 to 68+/-2 mm Hg) and hydrochlorothiazide (161+/-4 to 145+/-4 mm Hg; 78+/-2 to 73+/-2 mm Hg) treatment. Sympathetic nervous system activity was significantly reduced after spironolactone (plasma NE: 378+/-40 to 335+/-20 pg/mL, P=0.04; [(3)H]-NE release rate: 2.74+/-0.3 to 1.97+/-0.2 microg/min per meter squared, P=0.04) but not hydrochlorothiazide (plasma NE: 368+/-25 to 349+/-23 pg/mL, P=0.47; [(3)H]-NE release rate: 2.63+/-0.4 to 2.11+/-0.2 mg/min per meter squared, P=0.21). alpha-Adrenergic responsiveness was unchanged with either drug treatment. These findings demonstrate a beneficial effect of aldosterone receptor blockade on reducing sympathetic nervous system activity and blood pressure in hypertensive older patients.
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Wray et al. (2010) conducted an RCT in stage 1 hypertension (n=36). Spironolactone vs. Hydrochlorothiazide was evaluated on Sympathetic nervous system activity (plasma norepinephrine) (p=0.04). Spironolactone significantly reduced sympathetic nervous system activity (plasma NE P=0.04) and blood pressure in older hypertensive patients, whereas hydrochlorothiazide did not.
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