April 1, 2002Open Access
View Full PaperThe role of spironolactone in the treatment of patients with refractory hypertension
Structured PICO
Does spironolactone improve blood pressure control in patients with refractory hypertension?
P
Population
25 patients with refractory hypertension (hypertension ≥6 months without apparent cause, clinical and mean 24-h ambulatory BP >140/90 mm Hg despite treatment with at least two antihypertensive drugs, no prior spironolactone, no renal insufficiency) referred to a single medical clinic.
I
Intervention
Spironolactone 1 mg/kg/day added to previous antihypertensive regimen (with any angiotensin converting enzyme inhibitor suppressed).
O
Outcome
Blood pressure control (clinical BP < 140/90 mm Hg and ambulatory BP monitoring) at 1 month.surrogate
The addition of spironolactone significantly reduces blood pressure and the number of required antihypertensive medications in patients with refractory hypertension.
Abstract
BACKGROUND: Hypertension is resistant to pharmacologic therapy in 5% to 10% of patients. The current study tested whether addition of spironolactone to the treatment of patients with refractory hypertension would lead to adequate blood pressure (BP) control. METHODS: Among 520 patients who were referred for treatment of hypertension to one medical clinic from 1997 to 1999, a total of 25 patients who met the inclusion criteria of refractory hypertension were prospectively included in this study. The inclusion criteria were as follows: 1) hypertension of > or = 6 months without any apparent cause; 2) clinical BP measurement and mean 24-h ambulatory BP monitoring > 140/90 mm Hg despite treatment with at least two antihypertensive drugs; 3) no prior therapy with spironolactone; and 4) no renal insufficiency. Spironolactone was added to the previous regimen at a dosage of 1 mg/kg/day while any angiotensin converting enzyme inhibitor was suppressed. Serum potassium and creatinine levels were checked before the introduction of spironolactone and 1 month later. RESULTS: After 1 month of therapy with spironolactone, 23 patients had a clinical BP < 140/90 mm Hg. Ambulatory BP monitoring when compared before and 1 month after initiation of spironolactone decreased significantly (systolic BP from 152 +/- 2 mm Hg to 128 +/- 2 mm Hg, P < .001; and diastolic BP from 86 +/- 2 mm Hg to 76 +/- 2 mm Hg, P < .013). By 3 months after the introduction of spironolactone, the mean number of antihypertensive drugs required per patient was significantly reduced (from 3.2 +/- 0.2 to 2.1 +/- 0.2, P < .001). No patient required discontinuation of spironolactone due to adverse renal effects. CONCLUSION: Spironolactone is a safe, effective therapy for patients with refractory hypertension.