Spironolactone in patients with resistant hypertension

BACKGROUND AND OBJECTIVE: The aim of the study was to assess the effect of adding spironolactone to hypertensive resistant (HTR) patients and characterize those who respond effectively. PATIENTS AND METHOD: 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). RESULTS: 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 nmHg = 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] = 3197; 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. CONCLUSIONS: The addition of spironolactone effectively lowers BP in patients with HTR treated with 3 drugs. BP control is more difficult to achieve in diabetics.