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Cited by 58Blood Pressure and Hypertension StudiesHormonal Regulation and HypertensionRenin-Angiotensin System Studies

Efficacy and Safety of Spironolactone in Patients with Resistant Hypertension: A Meta-analysis of Randomised Controlled Trials

Wang, Chunbin, Xiong, Bo, Huang, Jing·2016·Heart, Lung and Circulation
DOI 10.1016/j.hlc.2016.02.016
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Abstract

Background The treatment of resistant hypertension (RH) is challenging. Several observational studies have suggested that the addition of spironolactone to triple-drug therapy might have a promising anti-hypertensive effect on RH. To provide more definite evidence for the benefit of spironolactone, we performed a meta-analysis of randomised controlled trials (RCTs) to evaluate the efficacy and safety of spironolactone in RH patients.Methods Articles were searched from PubMed, EMBASE and Cochrane Library. Randomised controlled trials investigating the effect of additional spironolactone on office blood pressure (BP), ambulatory BP or adverse events in RH patients were included for analysis. Then quality assessment, subgroup, sensitivity, and publication bias analyses were performed.Results Five RCTs involving a total of 553 patients were eligible for inclusion. Compared with control therapies, additional spironolactone treatment in RH patients significantly decreased 24-h ambulatory systolic BP (ASBP, weight mean difference [WMD]= -10.50, 95% confidence interval [CI] = -12.30 to -8.71, P<0.001), 24-h ambulatory diastolic BP (ADBP, WMD = -4.09, 95% CI = -5.28 to -2.91, P<0.001), daytime ASBP (WMD = -10.20, 95% CI = -12.41 to -7.99, P<0.001), daytime ADBP (WMD = -4.14, 95% CI = -5.50 to -2.78, P<0.001), night-time ASBP (WMD = -10.02, 95% CI = -12.63 to -7.41), night-time ADBP (WMD=-3.21, 95% CI=-4.84 to -1.58, P<0.001), office systolic BP (WMD=-16.99, 95% CI=-25.04 to -8.95, P<0.001) and office diastolic BP (WMD=-6.18, 95% CI=-9.30 to -3.05, P<0.001). However, serum potassium might be slightly elevated by additional spironolactone (WMD=0.181, 95% CI=0.042 to 0.319, P=0.011).Conclusion Spironolactone combined with triple-drug therapy may be an effective and relatively safe strategy for the management of RH patients.

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Authors
Wang, C., Xiong, B., & Huang, J.
Affiliations
Second Affiliated Hospital of Chongqing Medical University (CN)
Corresponding author
Huang, Jing
ORCID
Venue
Heart, Lung and Circulation
Publisher
Elsevier BV
Published
2016-10
Volume
25
Issue
10
Pages
1021-1030
ISSN
1443-9506 (ISSN-L)
DOI
10.1016/j.hlc.2016.02.016
OpenAlex
W2315872700
Cited by
58
References
33
Citations by year
2026: 5 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 8 · 2021: 6 · 2020: 7 · 2019: 8 · 2018: 7 · 2017: 2 · 2016: 3
FWCI
1.18
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Heart Lung and Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
Keywords
spironolactone, resistant hypertension, antihypertensive therapy, triple therapy, ambulatory blood pressure, office blood pressure, adverse events, drug safety, mineralocorticoid receptor antagonists, antihypertensive efficacy, nocturnal blood pressure dipping, renin-angiotensin system blockade, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers
MeSH terms
Drug Resistance, Humans, Hypertension, Spironolactone, Randomized Controlled Trials as Topic

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