Spironolactone in modern cardiology: from many years of experience to the latest evidence of effectiveness (literature review)

Abstract

Spironolactone is a drug that plays an important role in the treatment of various diseases, especially in the field of cardiology and endocrinology. First synthesized in 1957, spironolactone gained widespread recognition due to its unique ability to block the action of aldosterone, a hormone that plays an important role in the pathogenesis of many cardiovascular diseases and increases the risk of severe cardiovascular complications. Spironolactone is included in the list of essential medicines of the World Health Organization. In cardiology, it is one of the universal remedies, because it is prescribed for resistant or secondary hypertension, heart failure, as part of hormonal therapy and in a number of other clinical conditions and situations. Resistant hypertension is a complex and serious medical problem, which is a significant challenge for doctors and patients, as it requires a specialized and individualized approach to treatment. Clinical studies found that spironolactone was the most effective adjunctive drug for the management of resistant hypertension, and this superiority of spironolactone confirmed the central role of sodium retention in the development of treatment resistance. Studies have shown that the addition of spironolactone to initial combination therapy resulted in a more potent antihypertensive effect compared to the addition of doxazosin or bisoprolol. The proportion of patients in whom spironolactone was the optimal blood pressure-lowering drug appeared to be the largest, according to the analysis on the prediction of the effect of each drug on the blood pressure level using plasma renin and the probability that different drugs will be best at different points of renin distribution in the blood plasma. Spironolactone has been used in modern cardiology for a long time to treat patients with heart failure and atrial fibrillation, but in this article, we have focused on another very important site for spironolactone administration, namely hypertension, especially in its resistant forms.