BACKGROUND: There are currently limited data on whether the effect of spironolactone in patients with resistant arterial hypertension depends on age and sex. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

Department of Internal Medicine 1 Cardiology University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

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Effect of spironolactone in resistant arterial hypertension: a randomized, double-blind, placebo-controlled trial (ASPIRANT-EXT)