The role of spironolactone in the treatment of patients with refractory hypertension.
BACKGROUND
Hypertension is resistant to pharmacologic therapy in 5% to 10% of patients. The current study tested whether addition of spironolactone to the treatment of patients with refractory hypertension would lead to adequate blood pressure (BP) control.


METHODS
Among 520 patients who were referred for treatment of hypertension to one medical clinic from 1997 to 1999, a total of 25 patients who met the inclusion criteria of refractory hypertension were prospectively included in this study. The inclusion criteria were as follows: 1) hypertension of > or = 6 months without any apparent cause; 2) clinical BP measurement and mean 24-h ambulatory BP monitoring > 140/90 mm Hg despite treatment with at least two antihypertensive drugs; 3) no prior therapy with spironolactone; and 4) no renal insufficiency. Spironolactone was added to the previous regimen at a dosage of 1 mg/kg/day while any angiotensin converting enzyme inhibitor was suppressed. Serum potassium and creatinine levels were checked before the introduction of spironolactone and 1 month later.


RESULTS
After 1 month of therapy with spironolactone, 23 patients had a clinical BP < 140/90 mm Hg. Ambulatory BP monitoring when compared before and 1 month after initiation of spironolactone decreased significantly (systolic BP from 152 +/- 2 mm Hg to 128 +/- 2 mm Hg, P < .001; and diastolic BP from 86 +/- 2 mm Hg to 76 +/- 2 mm Hg, P < .013). By 3 months after the introduction of spironolactone, the mean number of antihypertensive drugs required per patient was significantly reduced (from 3.2 +/- 0.2 to 2.1 +/- 0.2, P < .001). No patient required discontinuation of spironolactone due to adverse renal effects.


CONCLUSIONS
Spironolactone is a safe, effective therapy for patients with refractory hypertension.
Ouzan
James
J
Medical Clinic, Reims, France. 101363.3035@compuserve.com
Pérault
Catherine
C
Lincoff
A Michael
AM
Carré
Evelyne
E
Mertes
Michel
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D013148:Spironolactone / Q000627:therapeutic use*
D013148:Spironolactone; D000450:Aldosterone; D012083:Renin