Efficacy of Add-On Aldosterone Receptor Blocker in Uncontrolled Hypertension

• Published in: American journal of hypertension 2006-07, Vol.19 (7), p.750-755
• Main Authors: Sharabi, Yehonatan, Adler, Eldad, Shamis, Ari, Nussinovitch, Naomi, Markovitz, Avinoam, Grossman, Ehud
• Format: Article
• Language: English
• Subjects: Aged; aldosterone; Antihypertensive agents; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - drug effects; Blood Pressure Determination; Cardiology. Vascular system; Cardiovascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Female; Humans; Hypertension - drug therapy; Male; Medical sciences; Middle Aged; Mineralocorticoid Receptor Antagonists - therapeutic use; Pharmacology. Drug treatments; potassium; Potassium - blood; renin; Retrospective Studies; Spironolactone; Spironolactone - therapeutic use; Treatment Outcome; uncontrolled hypertension
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/j.amjhyper.2005.11.016

Uncontrolled hypertension (UH) may be caused by hyperaldosteronism, and some experts recommend the routine use of aldosterone antagonists in this condition. The purpose of this study was to evaluate the efficacy of this approach and to characterize those who respond effectively to an add-on aldosterone antagonist. We retrospectively analyzed the effectiveness of spironolactone, an aldosterone antagonist, used as add-on therapy, compared with a standard add-on treatment, in patients referred to a hypertension clinic with UH despite the use of two or more antihypertensive drugs. A total of 340 patients (186 male) with an average age of 63 ± 14 years were followed for at least 3 months. Of the patients, 42 received add-on spironolactone and 298 received an additional antihypertensive drug other than spironolactone. Baseline characteristics were similar in both groups. Blood pressure (BP) decreased significantly in both groups. In patients who received spironolactone, BP decreased by 23.2/12.5 mm Hg from 165 ± 27/94 ± 15 to 142 ± 25/81 ± 9 mm Hg, whereas in patients who received other add-on therapy BP decreased by 7.6/5.8 mm Hg from 160 ± 24/91 ± 12 to 152 ± 20/85 ± 11 mm Hg ( P < .05). Patients who received spironolactone had lower serum potassium levels than those who did not receive spironolactone 3.8 ± 0.4 v 4.5 ± 0.5 mmol/L respectively ( P < .001). Potassium levels