Low-dose spironolactone in the management of resistant hypertension: a surveillance study

Methods We have conducted an open observational study of the use of spironolactone 25–50 mg in the management of patients with resistant hypertension. This drug was recommended in 133 patients who were already receiving an angiotensin-blocking drug in addition to other therapies. Results Of these, three defaulted from follow-up and 11 could not tolerate spironolactone. We therefore have outcome data on 119 patients. The addition of spironolactone (median dose 25 mg) was associated with a mean (SD) fall in systolic blood pressure of 21.7 mmHg (24.0; P < 0.001) and diastolic blood pressure of 8.5 mmHg (14.9; P < 0.001). In two patients spironolactone had to be discontinued on account of a rise of serum potassium to above 6.0 mmol/l, whereas overall the mean increase in serum potassium was 0.3 mmol/l. Conclusion With careful monitoring of plasma electrolytes, spironolactone at a low dose is an effective add-in drug in patients with hypertension resistant to a regime that includes an angiotensin-blocking agent.

[1]  T. Marshall.  How many antihypertensives do patients need to achieve a target blood pressure? , 2005, Journal of Human Hypertension.

[2]  J F Potter,et al.  Extract from : , 2009 .

[3]  D. Calhoun,et al.  Efficacy of low-dose spironolactone in subjects with resistant hypertension. , 2003, American journal of hypertension.

[4]  T. Welte,et al.  Interaction of spironolactone with ACE inhibitors or angiotensin receptor blockers: analysis of 44 cases , 2003, BMJ : British Medical Journal.

[5]  B. Pitt,et al.  Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction , 2003 .

[6]  B. Pitt,et al.  EPLERENONE POST-ACUTE MYOCARDIAL INFARCTION HEART FAILURE EFFICACY AND SURVIVAL STUDY INVESTIGATORS. EPLERENONE, A SELECTIVE ALDOSTERONE BLOCKER, IN PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION AFTER MYOCARDIAL INFARCTION , 2003 .

[7]  H. Krum,et al.  Efficacy of Eplerenone Added to Renin-Angiotensin Blockade in Hypertensive Patients , 2002, Hypertension.

[8]  A. Lincoff,et al.  The role of spironolactone in the treatment of patients with refractory hypertension. , 2001, American journal of hypertension.

[9]  M. Brown,et al.  Is resistant hypertension really resistant? , 2001, American journal of hypertension.

[10]  M. Burnier,et al.  Electronic compliance monitoring in resistant hypertension: the basis for rational therapeutic decisions , 2001, Journal of hypertension.

[11]  G. Bakris,et al.  Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. , 2000, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[12]  B. Pitt,et al.  The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure , 2000 .

[13]  B. Pitt,et al.  The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. , 1999, The New England journal of medicine.

[14]  Joël Ménard,et al.  Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial , 1998, The Lancet.

[15]  J. Cutler,et al.  Effect of Antihypertensive Drug Treatment on Cardiovascular Outcomes in Women and Men , 1997, Annals of Internal Medicine.

[16]  M. Brodie,et al.  Relation between dose of bendrofluazide, antihypertensive effect, and adverse biochemical effects. , 1990, BMJ.

[17]  Spironolactone: no longer for hypertension , 1988, Drug and therapeutics bulletin.

[18]  Patrice Degoulet,et al.  Factors predictive of attendance at clinic and blood pressure control in hypertensive patients. , 1983, British medical journal.

[19]  L. Ramsay,et al.  Amiloride, spironolactone, and potassium chloride in thiazide‐treated hypertensive patents , 1980, Clinical pharmacology and therapeutics.