The Role of Spironolactone in the Treatment of Patients with Resistant Hypertension

Introduction: Antihypertension agents fail to Control blood pressure (BP) in some patients even when double, triple, or even quadruple drug therapies are
administered.Patients with resistant hypertension participated in a study to determine wether spironolactone , added to the treatment regimen would improve
BP control.

Methods: Among 250 patients referred to a clinic for treatment of hypertension, 25 met inclusion criteria. Eligible patients had hypertension of 6 months or
greater duration with no apparent cause and continued to have clinical BP measurements and mean 24-hour ambulatory BP monitoring of greater than 140/90 mm HG after
treatment with at least 2 antihypertensive agents. Excluded were patients with renal insufficiency and those previously treated with spironolactone. Spironolactone
wasgiven at a dose of 25 mg per day.If adequate BP control was achieved with spironolactone, an additional antihypertensive agent was eliminated .
Serum potassium and creatinine levels were recorded before spironolactone was introduced and 1 month later.

Results: Twenty-three of 25 patients had a clinical BP less than 140/90 MM Hg after one month of spironolactone therapy. Both systolic and diastolic
ambulatory BP decreased significantly after one month: systolic from a mean of 152 to 128 mm Hg and diastolic from a mean of 86 to 76 mm Hg . After 3 months
ofspironolactone therapy the mean number of antihypertensive drugs required per patient was significantly reduced from 2.1 to 2.1.No adverse renal effects were
associated with spironolactone.

Conclusion: In this small group of patients with refractory hypertension, nearly all achieved adequate BP with the introduction of spironolactone. Some other
agents could be discontinued, thereby simplifying the patients`drug regimen.