Spironolactone for all hypertensive patients?

Rosendorff, Clive

doi:10.1097/hjh.0b013e328334262f

Cited by 1 publication

(1 citation statement)

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“…We might use spironolactone in patients with resistant hypertension without further testing, as some authors suggest, 15,16 which is a concept advocated by many GPs. On the other hand, our study supports literature findings that demonstrate a benefit of surgical treatment of aldosterone-producing tumors-a therapy with proven cost effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Hyperaldosteronism in Primary Care Patients with Resistant Hypertension

Schmiemann¹,

Gebhardt²,

Hummers-Pradier³

et al. 2012

The Journal of the American Board of Family Medicine

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Introduction: Because hyperaldosteronism is the most common curable reason for secondary hypertension, screening is recommended. However, prevalence among general practice patients and feasibility of screening is still unclear. A design to assess prevalence in general practice and barriers against screening was created.Methods: This was an open, observational pilot study and focus group. In 2 general practices, all patients with arterial hypertension were included. Those with resistant hypertension (>140/90 mm Hg and taking >3 antihypertensive drugs) were eligible for screening. The design and feasibility of the study were discussed in a focus group of experienced general practitioners.Results: Of 3107 patients visiting the practices, 564 were diagnosed as having arterial hypertension. Seventy-nine fulfilled criteria for resistant hypertension. Aldosterone:renin ratio (ARR) could be measured in 63 of those patients. Withdrawal of ß-blocker was feasible in 34 of the 63 with measurable ARR. ARR was positive in 15, and in 3 of those 15 with positive ARR, it was caused by elevated aldosterone levels. Focus group discussion revealed barriers and concerns regarding organizational, financial, and practical aspects of a systematic screening.Conclusions: Screening for hyperaldosteronism in general practice seems possible in selected patients, but not in a systematic way. Barriers against systematic screening were a necessity for ␤-blocker cessation as well as structural prerequisites for patient identification.

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Section: Discussionmentioning

confidence: 99%