Effect of low-dose spironolactone on resistant hypertension in type 2 diabetes mellitus: a randomized controlled trial in a sub-Saharan African population

• Published in: BMC research notes Vol. 9; no. 1; p. 187
• Main Authors: Djoumessi, Romance Nguetse, Noubiap, Jean Jacques N, Kaze, Francois Folefack, Essouma, Mickael, Menanga, Alain Patrick, Kengne, Andre Pascal, Mbanya, Jean Claude, Sobngwi, Eugene
• Format: Journal Article
• Language: English
• Published: England BioMed Central 23.03.2016
• Subjects: Africa South of the Sahara; Blood Pressure - drug effects; Creatinine - blood; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - physiopathology; Dose-Response Relationship, Drug; Female; Humans; Hypertension - blood; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; Male; Middle Aged; Potassium - blood; Sodium - blood; Spironolactone - administration & dosage; Spironolactone - pharmacology; Spironolactone - therapeutic use; Cameroon; Type 2 diabetes mellitus; Resistant hypertension; Spironolactone; Sub-Saharan Africa
• ISSN: 1756-0500; 1756-0500
• DOI: 10.1186/s13104-016-1987-5

Low-dose spironolactone has been proven to be effective for resistant hypertension in the general population, but this has yet to be confirmed in type 2 diabetic (T2DM) patients. We assessed the efficacy of a low-dose spironolactone on resistant hypertension in a sub-Saharan African population of T2DM patients from Cameroon. This was a four-week single blinded randomized controlled trial in 17 subjects presenting with resistant hypertension in specialized diabetes care units in Cameroon. They were randomly assigned to treatment with a daily 25 mg of spironolactone (n = 9) or to an alternative antihypertensive regimen (n = 8), on top of any ongoing regimen and prevailing lifestyle prescriptions. They were seen at the start of the treatment, then 2 and 4 weeks later. The primary outcome was change in office and self-measured blood pressure (BP) during follow-up, and secondary outcomes were changes in serum potassium, sodium, and creatinine levels. Compared with alternative treatment, low-dose spironolactone was associated with significant decrease in office systolic BP (-33 vs. -14 mmHg; p = 0.024), and in diastolic BP (-14 vs. -5 mmHg; p = 0.006). After 1 month of spironolactone, all the patients were controlled based on BP below 130/80 mmHg, with significant office BP reduction from 158 ± 17/86 ± 11 to 125 ± 11/72 ± 8, vs. 158 ± 8/94 ± 8 to 144 ± 17/89 ± 12 mmHg in the alternative treatment group. There was no significant variation in sodium and creatinine levels in both groups, but a mild increase of potassium levels in the spironolactone group. Add-on low-dose spironolactone was effective in reducing BP to optimal levels in T2DM Cameroonian patients despite mild increase in serum potassium. Trial registration ClinicalTrials.gov Identifier NCT02426099. Date of registration April 2015.