Document Detail


Effect of spironolactone on blood pressure in subjects with resistant hypertension.
MedLine Citation:
PMID:  17309946     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Spironolactone is recommended as fourth-line therapy for essential hypertension despite few supporting data for this indication. We evaluated the effect among 1411 participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm who received spironolactone mainly as a fourth-line antihypertensive agent for uncontrolled blood pressure and who had valid BP measurements before and during spironolactone treatment. Among those who received spironolactone, the mean age was 63 years (SD: +/-8 years), 77% were men, and 40% had diabetes. Spironolactone was initiated a median of 3.2 years (interquartile range: 2.0 to 4.4 years) after randomization and added to a mean of 2.9 (SD: +/-0.9) other antihypertensive drugs. The median duration of spironolactone treatment was 1.3 years (interquartile range: 0.6 to 2.6 years). The median dose of spironolactone was 25 mg (interquartile range: 25 to 50 mg) at both the start and end of the observation period. During spironolactone therapy, mean blood pressure fell from 156.9/85.3 mm Hg (SD: +/-18.0/11.5 mm Hg) by 21.9/9.5 mm Hg (95% CI: 20.8 to 23.0/9.0 to 10.1 mm Hg; P<0.001); the BP reduction was largely unaffected by age, sex, smoking, and diabetic status. Spironolactone was generally well tolerated; 6% of participants discontinued the drug because of adverse effects. The most frequent adverse events were gynecomastia or breast discomfort and biochemical abnormalities (principally hyperkaliemia), which were recorded as adverse events in 6% and 2% of participants, respectively. In conclusion, spironolactone effectively lowers blood pressure in patients with hypertension uncontrolled by a mean of approximately 3 other drugs. Although nonrandomized and not placebo controlled, these data support the use of spironolactone in uncontrolled hypertension.
Authors:
Neil Chapman; Joanna Dobson; Sarah Wilson; Björn Dahlöf; Peter S Sever; Hans Wedel; Neil R Poulter;
Related Documents :
18353996 - Effect of sitagliptin, a dipeptidyl peptidase-4 inhibitor, on blood pressure in nondiab...
7721386 - Effect of antihypertensive treatment on small arteries of patients with previously untr...
23096426 - Volatile isoflurane sedation in cerebrovascular intensive care patients using anaconda(...
24250976 - Administration of remifentanil in establishing a more stable post-anesthesia cardiovasc...
1836766 - The effect of altering airway tone on the sensitivity of the cough reflex in normal vol...
9580526 - Isolated kidney controlled perfusion with true physiological pulsatile waveform.
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-02-19
Journal Detail:
Title:  Hypertension     Volume:  49     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-22     Completed Date:  2007-04-05     Revised Date:  2009-01-07    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  839-45     Citation Subset:  IM    
Affiliation:
International Centre for Circulatory Health, Imperial College London, 59 North Wharf Rd, London W2 1PG, United Kingdom. neil.chapman@st-marys.nhs.uk
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Aldosterone Antagonists / adverse effects,  therapeutic use*
Antihypertensive Agents / therapeutic use
Blood Pressure / drug effects*
Breast / drug effects
Drug Resistance
Female
Gynecomastia / chemically induced
Humans
Hyperkalemia / chemically induced
Hypertension / drug therapy*
Male
Middle Aged
Pain / chemically induced
Retreatment
Spironolactone / adverse effects,  therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Aldosterone Antagonists; 0/Antihypertensive Agents; 52-01-7/Spironolactone
Comments/Corrections
Comment In:
Hypertension. 2007 Apr;49(4):763-4   [PMID:  17309945 ]
Hypertension. 2007 Sep;50(3):e57; author reply e58   [PMID:  17606857 ]
Curr Hypertens Rep. 2008 Jun;10(3):211-2   [PMID:  18765091 ]
J Clin Hypertens (Greenwich). 2007 Jul;9(7):579-81   [PMID:  17668495 ]
Hypertension. 2007 Nov;50(5):e164-5; author reply e166   [PMID:  17846345 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Pregnancy-induced hypertension in women who were born small.
Next Document:  Morning blood pressure surge as a destabilizing factor of atherosclerotic plaque: role of ubiquitin-...