Spironolactone for hypertension

Batterink, Josh; Stabler, Sarah; Tejani, Aaron M; Fowkes, Curt T

doi:10.1002/14651858.cd008169.pub2

Cited by 52 publications

(48 citation statements)

References 44 publications

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“…4 Spironolactone is a mineralocorticoid receptor antagonist that was shown to lower BP effectively in both general hypertensive patients and patients with primary aldosteronism. [5][6][7] A number of small, uncontrolled trials showed the positive effect of small doses of spironolactone in lowering BP in patients with resistant arterial hypertension. 8 -11 In the nonrandomized post hoc analysis of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm, the addition of spironolactone to a triple-drug treatment led, during an average of 1.3 years of follow-up, to a significant decrease of systolic BP of 21.9 mm Hg and diastolic BP of 9.5 mm Hg.…”

mentioning

confidence: 99%

Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT)

Václavík

Sedlak²,

Plachý³

et al. 2011

Hypertension

268

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Abstract-There is currently limited data on which drug should be used to improve blood pressure (BP) control in patients with resistant hypertension. This study was designed to assess the effect of the addition of 25 mg of spironolactone on BP in patients with resistant arterial hypertension. Patients with office systolic BP Ͼ140 mm Hg or diastolic BP Ͼ90 mm Hg despite treatment with at least 3 antihypertensive drugs, including a diuretic, were enrolled in this double-blind, placebo-controlled, multicenter trial. One hundred seventeen patients were randomly assigned to receive spironolactone (nϭ59) or a placebo (nϭ58) as an add-on to their antihypertensive medication, by the method of simple randomization. Analyses were done with 111 patients (55 in the spironolactone and 56 in the placebo groups). At 8 weeks, the primary end points, a difference in mean fall of BP on daytime ambulatory BP monitoring (ABPM), between the groups was Ϫ5.4 mm Hg (95% CI Ϫ10.0; Ϫ0. R esistant hypertension is a common clinical problem faced by both primary care clinicians and specialists worldwide. It is defined as blood pressure (BP) that remains above goal despite the concurrent use of 3 antihypertensive agents of different classes prescribed at optimal dosages; one of the 3 agents used should be a diuretic. 1 The exact prevalence of resistant hypertension is not known, but it is estimated from large clinical trials to affect at least 10% to 15% of all hypertensive patients. 2,3 If no secondary cause of hypertension is found, the use of multidrug treatment regimens including 3, 4, or more antihypertensive drugs is usually necessary to lower BP and thus prevent future cardiovascular events. 4 Spironolactone is a mineralocorticoid receptor antagonist that was shown to lower BP effectively in both general hypertensive patients and patients with primary aldosteronism. 5-7 A number of small, uncontrolled trials showed the positive effect of small doses of spironolactone in lowering BP in patients with resistant arterial hypertension. 8 -11 In the nonrandomized post hoc analysis of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm, the addition of spironolactone to a triple-drug treatment led, during an average of 1.3 years of follow-up, to a significant decrease of systolic BP of 21.9 mm Hg and diastolic BP of 9.5 mm Hg. 12 However, evidence from randomized trials was lacking, and it was necessary to provide definite proof for the efficacy of spironolactone as an add-on treatment in resistant hypertension. 12,13 Therefore, we designed a prospective randomized trial to evaluate the effect of adding spironolactone in patients with resistant arterial hypertension. We decided to administer a low dose of spironolactone (25 mg/day) in the trial, since the effect of this dose seemed to be substantial

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mentioning

confidence: 99%

Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT)

Václavík

Sedlak²,

Plachý³

et al. 2011

Hypertension

268

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“…Nevertheless, guidelines for the management of PA recommend discontinuing spironolactone at least 4 weeks before assaying plasma renin and aldosterone for the diagnosis of the condition and, indeed, extend this recommendation to eplerenone (7). Spironolactone has been given once daily at doses ranging from 1 to 4 mg/kg body weight per day in patients with essential hypertension or with APAs, but there is little evidence that doses O50 mg/day lead to a greater reduction in BP (8). Spironolactone is associated with various sexsteroid-related adverse effects, mainly breast tenderness, menstrual abnormalities, decreased libido, and impotence, with an incidence rate of 6.9% at doses of 50 mg/day or less and exceeding 50% at doses of 150 mg/day or more (9).…”

Section: Spironolactonementioning

confidence: 99%

PROGRESS IN PRIMARY ALDOSTERONISM: Mineralocorticoid antagonist treatment for aldosterone-producing adenoma

Amar

Lorthioir

Azizi

et al. 2015

European Journal of Endocrinology

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Mineralocorticoid receptor antagonists have been used in patients with aldosterone-producing adenomas (APAs) as a test designed to predict the blood pressure (BP) outcome of surgery. They are commonly used in patients undergoing adrenalectomy to reduce BP and increase plasma potassium levels during the preoperative period. A small number of studies have compared the effects of surgery and mineralocorticoid antagonists either on BP, on serum potassium levels, or on the incidence of cardiovascular and renal outcomes in patients with primary aldosteronism with or without an APA; these studies found no difference between the two therapeutic options. Mineralocorticoid receptor antagonists can be used as a maintenance treatment for patients with APAs, who are judged to be poor operative risks or who do not want to undergo surgery.

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“…Un reciente meta-análisis, que incluyó 5 estudios cruzados en pacientes con HTA esencial seguidos por 4-6 semanas, señaló que espironolactona reduce la presión arterial de forma significativa ( = -20,01/-6,75 mmHg) 55 . Lamentablemente, el efecto antihipertensivo requiere de dosis de 100-500 mg/día, asociadas a un mayor riesgo de hiperkalemia 55,56 .…”

Section: Arm En Hipertensión Arterialunclassified

“…Lamentablemente, el efecto antihipertensivo requiere de dosis de 100-500 mg/día, asociadas a un mayor riesgo de hiperkalemia 55,56 . Sin embargo, estudios en población hipertensa con dosis bajas de espironolactona añadido a IECA/ARA2 han señalado una mejora de la función ventricular izquierda 26 .…”

Section: Arm En Hipertensión Arterialunclassified

Aplicaciones y proyecciones de los antagonistas del receptor de mineralocorticoides en el tratamiento de patologías cardiovasculares

et al. 2014

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Spironolactone for hypertension

Cited by 52 publications

References 44 publications

Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT)

Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT)

PROGRESS IN PRIMARY ALDOSTERONISM: Mineralocorticoid antagonist treatment for aldosterone-producing adenoma

Aplicaciones y proyecciones de los antagonistas del receptor de mineralocorticoides en el tratamiento de patologías cardiovasculares

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