Spironolactone Effective Add-on for Resistant Hypertension Patients
For patients with resistant hypertension who are already on a three-drug regimen, spironolactone is an effective add-on, according to a new study from The Lancet. In a double-blind, placebo-controlled, crossover trial, 355 subjects with systolic readings > 140 mmHg (or ≥ 135 mmHg for diabetics) were evaluated. All patients were already taking maximally tolerated doses of three drugs (ACEI/ARB, calcium-channel blocker, and a diuretic). They then rotated all patients through 12 weeks of treatment with spironolactone (25-50 mg), bisoprolol (5-10 mg), doxazosin modified release (4-8 mg), and placebo, in addition to their baseline drugs. Spironolactone was superior to placebo in lowering systolic blood pressure by 8.7 mmHg (95% confidence interval; -9.72 to -7.69; P < 0.0001). Spironolactone was also superior to the mean of the two other active treatments (doxazosin and bisoprolol; -4.26 mmHg) and each drug individually (-4.03 mmHg vs doxazosin and -4.48 mmHg vs bisoprolol; P < 0.0001 for all comparisons). Six of the 285 patients taking spironolactone had elevated potassium readings on one occasion. The authors concluded that spironolactone was the most effective add-on drug for treatment of resistant hypertension, suggesting that sodium retention plays a role in this condition (Lancet published online; doi: http://dx.doi.org/10.1016/S0140-6736(15)00257-3).
Spironolactone was the most effective add-on drug for treatment of resistant hypertension, suggesting that sodium retention plays a role in this condition.
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