Effect of spironolactone in patients with resistant arterial hypertension in relation to age and sex: Insights from the aspirant trial

Jan Vaclavik,Richard Sedlak,Eva Kocianova,Jiri Jarkovsky,Milos Taborsky

doi:10.5507/bp.2012.105

Jan Vaclavik, Richard Sedlak + Show 3 more

Open Access

https://doi.org/10.5507/bp.2012.105

Copy DOI

Abstract

There are currently limited data on whether the effect of spironolactone in patients with resistant arterial hypertension depends on age and sex. Patients with an office systolic blood pressure (BP)>140 mmHg or diastolic BP>90 mmHg, despite treatment with at least 3 antihypertensive drugs including a diuretic, were randomly assigned to receive spironolactone or a placebo for 8 weeks in a double-blind, placebo-controlled, multicentre trial (ASPIRANT). Analyses were done on 55 patients treated with spironolactone and 56 patients treated with placebo. Significant reductions of office systolic BP (-8.9±6.7 mmHg, P=0.012), 24-h ABPM systolic BP (-7.9±7.2 mmHg, P=0.032) and ABPM day-time systolic BP (-7.5±7.1 mmHg) after 8 weeks of spironolactone treatment, compared to placebo, were only observed in patients with a median age>62 years. The office and ABPM systolic BP reductions in patients aged ≤62 years and diastolic BP reductions by spironolactone in both age groups were not significant compared to placebo. Women tended to have a nonsignificantly higher reduction in systolic BP with spironolactone treatment, and there was no difference in diastolic BP reduction between women and men. Spironolactone only leads to a reduction of systolic BP in older patients with resistant arterial hypertension aged >62 years, and is effective to a similar extent in men and women.

Highlights

Resistant hypertension is defined as blood pressure (BP) that remains above goal in spite of the concurrent use of 3 antihypertensive agents of different classes prescribed at optimal dosages; one of the 3 agents used should be a diuretic[1].Spironolactone is a mineralocorticoid receptor antagonist which was shown to lower blood pressure effectively in patients with resistant arterial hypertension
Analyses were done with patients who were treated with spironolactone and patients treated by placebo who finished the trial
To assess whether the effect of spironolactone depended on age, patients were divided into two groups based on the median age of the spironolactone group (62 years)

Summary

Introduction

Resistant hypertension is defined as blood pressure (BP) that remains above goal in spite of the concurrent use of 3 antihypertensive agents of different classes prescribed at optimal dosages; one of the 3 agents used should be a diuretic[1].Spironolactone is a mineralocorticoid receptor antagonist which was shown to lower blood pressure effectively in patients with resistant arterial hypertension. A recent randomized, double-blind, placebo-controlled, multicentre trial (ASPIRANT) found a significant decrease of systolic, but not diastolic BP, with the addition of 25 mg of spironolactone compared to a placebo in patients with resistant hypertension[14]. There are only limited data on whether the effect of spironolactone treatment in patients with resistant arterial hypertension depends on age and sex. There are currently limited data on whether the effect of spironolactone in patients with resistant arterial hypertension depends on age and sex. Patients with an office systolic blood pressure (BP) >140 mmHg or diastolic BP >90 mmHg, despite treatment with at least 3 antihypertensive drugs including a diuretic, were randomly assigned to receive spironolactone or a placebo for 8 weeks in a double-blind, placebo-controlled, multicentre trial (ASPIRANT). Spironolactone only leads to a reduction of systolic BP in older patients with resistant arterial hypertension aged >62 years, and is effective to a similar extent in men and women

Methods

Results

Conclusion