title: Effect of low-dose spironolactone on resistant hypertension in type 2 diabetes mellitus: a randomized controlled trial in a sub-Saharan African population.
abstract: BACKGROUND
  Low-dose spironolactone has been proven to be effective for resistant hypertension in the general population, but this has yet to be confirmed in type 2 diabetic (T2DM) patients. We assessed the efficacy of a low-dose spironolactone on resistant hypertension in a sub-Saharan African population of T2DM patients from Cameroon.
  
  
  METHODS
  This was a four-week single blinded randomized controlled trial in 17 subjects presenting with resistant hypertension in specialized diabetes care units in Cameroon. They were randomly assigned to treatment with a daily 25 mg of spironolactone (n = 9) or to an alternative antihypertensive regimen (n = 8), on top of any ongoing regimen and prevailing lifestyle prescriptions. They were seen at the start of the treatment, then 2 and 4 weeks later. The primary outcome was change in office and self-measured blood pressure (BP) during follow-up, and secondary outcomes were changes in serum potassium, sodium, and creatinine levels.
  
  
  RESULTS
  Compared with alternative treatment, low-dose spironolactone was associated with significant decrease in office systolic BP (-33 vs. -14 mmHg; p = 0.024), and in diastolic BP (-14 vs. -5 mmHg; p = 0.006). After 1 month of spironolactone, all the patients were controlled based on BP below 130/80 mmHg, with significant office BP reduction from 158 ± 17/86 ± 11 to 125 ± 11/72 ± 8, vs. 158 ± 8/94 ± 8 to 144 ± 17/89 ± 12 mmHg in the alternative treatment group. There was no significant variation in sodium and creatinine levels in both groups, but a mild increase of potassium levels in the spironolactone group.
  
  
  CONCLUSIONS
  Add-on low-dose spironolactone was effective in reducing BP to optimal levels in T2DM Cameroonian patients despite mild increase in serum potassium. Trial registration ClinicalTrials.gov Identifier NCT02426099. Date of registration April 2015.
authors.affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: Romance Nguetse
authors.initials: RN
authors.lastname: Djoumessi
authors.affiliation: Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.|Medical Diagnostic Center, Yaoundé, Cameroon.
authors.forename: Jean Jacques N
authors.initials: JJ
authors.lastname: Noubiap
authors.affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: Francois Folefack
authors.initials: FF
authors.lastname: Kaze
authors.affiliation: Division of Medicine, Sangmelima's Reference Hospital, Sangmelima, Cameroon.
authors.forename: Mickael
authors.initials: M
authors.lastname: Essouma
authors.affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: Alain Patrick
authors.initials: AP
authors.lastname: Menanga
authors.affiliation: Non-Communicable Diseases Research Unit, South African Medical Research Council and University of Cape Town, Cape Town, 7505, South Africa.
authors.forename: Andre Pascal
authors.initials: AP
authors.lastname: Kengne
authors.affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.|Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon.|Yaoundé Central Hospital and Faculty of Medicine and Biomedical Sciences, National Obesity Center, University of Yaoundé I, Yaoundé, Cameroon.
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Mbanya
authors.affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. sobngwieugene@yahoo.fr.|Laboratory for Molecular Medicine and Metabolism, Biotechnology Center, University of Yaoundé I, Yaoundé, Cameroon. sobngwieugene@yahoo.fr.|Yaoundé Central Hospital and Faculty of Medicine and Biomedical Sciences, National Obesity Center, University of Yaoundé I, Yaoundé, Cameroon. sobngwieugene@yahoo.fr.
authors.forename: Eugene
authors.initials: E
authors.lastname: Sobngwi
mesh_terms: D017954:Africa South of the Sahara; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D012964:Sodium / Q000097:blood; D013148:Spironolactone / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D013148:Spironolactone; D012964:Sodium; D003404:Creatinine; D011188:Potassium
keywords: Cameroon; Resistant hypertension; Spironolactone; Sub-Saharan Africa; Type 2 diabetes mellitus