Spironolactone in patients with resistant hypertension

• Published in: Medicina clínica Vol. 131; no. 11; p. 406
• Main Authors: Rodilla, Enrique, Costa, José A, Pérez-Lahiguera, Francisco, González, Carmen, Pascual, José M
• Format: Journal Article
• Language: Spanish
• Published: Spain 04.10.2008
• Subjects: Aged; Confidence Intervals; Diabetes Complications; Diuretics - administration & dosage; Diuretics - therapeutic use; Drug Resistance; Female; Follow-Up Studies; Humans; Hypertension - diagnosis; Hypertension - drug therapy; Logistic Models; Male; Middle Aged; Mineralocorticoid Receptor Antagonists - administration & dosage; Mineralocorticoid Receptor Antagonists - therapeutic use; Retrospective Studies; Risk Factors; Spironolactone - administration & dosage; Spironolactone - therapeutic use; Time Factors; Treatment Outcome
• ISSN: 0025-7753
• DOI: 10.1157/13126215

The aim of the study was to assess the effect of adding spironolactone to hypertensive resistant (HTR) patients and characterize those who respond effectively. Observational retrospective study on outpatients with HTR (being treated with at least 3 drugs at full doses, one of these being a diuretic) not achieving blood pressure (BP) goals, with normal creatinine values (< 1.6 mg/dl for males and < 1.4 mg/dl in women). A total of 95 patients (70% male), average (standard deviation) age of 66 (12) years (40% diabetics), were treated with spironolactone during 4 months (range: 2-13). Mean systolic and diastolic BP fell from 170/86 (20/14) mmHg, by 29/12 mmHg (95% confidence interval [CI], 25 to 33/10 to 14 mmHg; p = 0.001). At the end of follow-up, 38% of all patients achieved the goal of BP control. Initial systolic BP < 165 mmHg (odds ratio [OR] = 3,97; 95% CI, 1.52-10.37; p = 0.005), and diabetes (OR = 0.33; 95% CI, 0.13-0.86; p = 0.02) were the only independent factors related to BP control in a logistic regression analysis. The addition of spironolactone effectively lowers BP in patients with HTR treated with 3 drugs. BP control is more difficult to achieve in diabetics.