Abstract P2008: The Efficacy of Spironolactone in the Management of Uncontrolled Hypertension in Patients With Left Ventricular Hypertrophy and Diastolic Dysfunction in a Community Practice

Abstract

Uncontrolled hypertension with left ventricular hypertrophy and diastolic dysfunction causes major cardiovascular mortality and morbidity. There are few studies in medical literature examining the use of spironolactone in this high-risk population. The aim of this study is to evaluate the efficacy of spironolactone in this high-risk population in a community practice. The current study is a retrospective analysis of chart review of 92 patients with uncontrolled hypertension with left ventricular hypertrophy and diastolic dysfunction. All patients underwent 2-D echocardiography. Left ventricular hypertrophy and diastolic dysfunction were diagnosed using standard criteria from American Society of Echocardiography. Within the study population, 65% were already taking 3 antihypertensive drugs before spironolactone was added to the regimen. Blood pressure was recorded in the office after patient rested for 5 minutes in a quiet room. The patient follow-ups occurred every 12 to 16 weeks. Spironolactone was added as an add-on therapy with a dosage ranging from 25 to 50 mg daily. The goal blood pressure was defined as systolic pressure less than 135 mm Hg and diastolic pressure less than 85 mm Hg. Total patients with uncontrolled hypertension were 92 and consisted of 52 females and 40 males. The racial distribution of the population included 50 African Americans, 39 Caucasians, and 3 Asians. Patients with diabetes were 53% of the study population. A total of 62 patients out of the 92 (67%) patients reached the goal blood pressure. There were 32 out of 50 (64%) African Americans who reached the goal and 30 out of 39 (77%) Caucasians reached the goal. Hyperkalemia was seen in 7.6% of the population and gynecomastia was not seen.Given the data, we conclude that spironolactone therapy was effective in the management of uncontrolled hypertension with left ventricular hypertrophy and diastolic dysfunction in both Caucasian and African American populations in this study. Using a hypothesis test to compare the difference in proportion of two samples, we show statistical significance at a greater than 99% confidence level that the proportion of Caucasian patients who reached the goal was greater than the proportion of African American patients who reached the goal.