The role of aldosterone antagonists for resistant hypertension

This review examined evidence on the effectiveness of aldosterone antagonists in patients with resistant hypertension (RH). The authors concluded that aldosterone antagonists are effective in reducing blood pressure in patients with RH.

Patients with resistant hypertension (RH) have blood pressure levels consistently higher than 140/90 mm Hg. RH usually requires treatment with three or more drugs.

It has been estimated that 20% of patients with RH produce too much aldosterone (a steroid hormone). This condition is known as primary aldosteronism. It is believed that high levels of aldosterone can contribute to patients becoming resistant to hypertension treatments. Aldosterone antagonists are drugs that reduce the levels of aldosterone in the body. The most commonly used AAs include spironolactone (Aldactone) and eplerenone (Inspra). They cause the body to produce more urine, and urinate more frequently. By reducing the amount of fluid in the body, blood pressure can be lowered.

The authors reviewed a number of studies to compare the effects aldosterone antagonists in treating patients with RH.  

One study compared the effectiveness of different doses of spironolactone and eplerenone in 409 patients with RH. 50 mg of spironolactone twice daily reduced blood pressure by -16.9/-9.5 mm Hg. It took 400 mg of eplerenone to achieve a similar effect.

Another study looked at the effect of adding spironolactone treatment to existing treatment of 25 patients with RH. Systolic blood pressure (pressure when the heart is contracting) decreased significantly from 152 mm Hg to 128 mm Hg. Diastolic blood pressure (pressure when the heart is between beats) decreased from 86 mm Hg to 76 mm Hg.

Another study showed that spironolactone is effective in a broad range of patients. These included African American and Caucasian patients with a range of aldosterone levels.

In a number of studies, spironolactone was more effective than placebo (control drug with no active effect). It was particularly effective in obese patients with high-sodium diets. Patients on a high-sodium diet showed a significantly larger reduction in blood pressure, regardless of previous aldosterone levels.

The authors concluded that spironolactone is an effective treatment for resistant hypertension. Authors also suggested a role for it in counteracting the effects of a high-sodium diet, particularly in obese patients.

The data in this study was combined from a number of different studies. Methods and treatment duration varied across studies.