Spironolactone treatment in patients with diabetic microalbuminuria and resistant hypertension

Resistant hypertension is common in diabetes. Spironolactone by inhibiting aldosterone not only exerts antihypertensive effect but also antiproteinuric effect. In this study, the mean decrease in systolic and diastolic blood pressure after 4 weeks of spironolactone was 25.5 +/- 7.8 and 11.4 +/- 3.5 mmHg respectively and it increased further at 8 weeks and at 12 weeks, while there was no significant change in blood pressure in the control group. At 12 weeks, significantly greater reductions in both the systolic and diastolic blood pressure were observed in patients treated with spironolactone having serum potassium less than 4 meq/l vs those having serum potassium more than 4 meq/l. Reduction in urine microalbumin, though higher in patients with serum potassium less than 4 meq/l was not significant at any intervals.