title: A meta-analysis of add-on use of spironolactone in patients with resistant hypertension.
abstract: OBJECTIVE
  The efficacy of add-on use of spironolactone in patients with resistant hypertension has been investigated in several small studies. We performed this meta-analysis evaluating the efficacy of add-on use of spironolactone in these patients.
  
  
  METHODS
  We searched Pubmed, Web of Science, and Cochrane Central for all published studies evaluating add-on use of spironolactone in patients with resistant hypertension. Only randomized controlled trials determining antihypertensive effects of spironolactone were considered.
  
  
  RESULTS
  The antihypertensive effects were assessed in 869 patients included in 4 trials with a mean follow-up of 12±3weeks. The reduction of systolic blood pressure (SBP) and diastolic BP (DBP) in patients treated with spironolactone was greater than placebo (weighted mean differences (WMD) for SBP -16.67mmHg (95% confidence interval (CI), -27.54, -5.80), p<0.01; WMD for DBP -6.11mmHg (95% CI, -9.34, -2.88), p<0.001), respectively. The rates of serious adverse effects or patient withdrawals from the trials tended to be higher in patients treated with spironolactone than placebo (WMD for odds ratio 2.11 (95% CI, 0.98, 4.53), p=0.05).
  
  
  CONCLUSIONS
  This meta-analysis provides the evidence that add-on use of spironolactone in patients with resistant hypertension is effective in lowering SBP and DBP, suggesting an add-on use of spironolactone as fourth line therapy in patients with resistant hypertension.
authors.affiliation: Division of Hypertension, the First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China. Electronic address: emaildizhao@163.com.
authors.forename: Di
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Division of Endocrinology, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang 471000, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.affiliation: Division of Cardiology, the First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China.
authors.forename: Pingshuan
authors.initials: P
authors.lastname: Dong
authors.affiliation: Division of Cardiology, the First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, China.
authors.forename: Jingdong
authors.initials: J
authors.lastname: Zhao
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D013148:Spironolactone / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics; D013148:Spironolactone
keywords: Meta-analysis; Resistant hypertension; Spironolactone