The role of spironolactone in the treatment of patients with refractory hypertension

The aim of this study was to show how the adjunction of Spironolactone(Spi) to the treatment of refractory hypertensive patients (RH) might permit an optimal blood pressure (BP) control. Among all the 520 patients who have been referred for treatment of hypertension in a medical clinic from 1997 to 1999, 25 patients had refractory hypertension. The inclusion criteria were 1) hypertension of at least six months without any apparent cause 2)clinical BP above 140/90 mm Hg in spite of at least two antihypertensive drugs (AT) given at optimal dosage 3) no previous use of Spi 4) proper 24 hours ambulatory blood pressure monitoring (ABPM) showing an average BP above 140/90 mm Hg.Potassium and serum creatinine were checked before the introduction of Spi and one month after. In case of renal insufficiency (creatinine above 15 mg/l) patients were excluded from the treatment by Spi.If patients were on Angiotensin Converting Enzyme inhibitor (ACE), this drug was replaced by Spi at a dosage of 1 mg/kg. Otherwise, Spi was added to the previous treatment at the same dosage. After one month of treatment by Spi, 23 patients had a clinical BP below 140/90 mm Hg. On the whole population of RH patients, ABPM showed a significant decrease in both systolic (151.6 ±1.8 mm Hg to 128.6.±2 mm Hg p<0.001) and diastolic pressure (85.7 ± 1.8 mm Hg to 77.6 ± 1.8 mm Hg p<0.013). Three months after introduction of Spi, the decrease in the number of AT, which was made possible by the introduction of Spi, was highly significant (p<0.001). No biological side effect was observed. Two patients experienced clinical side effects. In these two cases, Spi was replaced by ACE, which turned out to be more effective after treatment by Spi than previously. Hypersecretion of Aldosterone may be underestimated in patients with RH. The use of Spi for these patients is safe, efficient and gives durable results, which leads to a simplification of the initial treatment.