A meta-analysis of add-on use of spironolactone in patients with resistant hypertension
Abstract
Objective The efficacy of add-on use of spironolactone in patients with resistant hypertension has been investigated in several small studies. We performed this meta-analysis evaluating the efficacy of add-on use of spironolactone in these patients.Methods We searched Pubmed, Web of Science, and Cochrane Central for all published studies evaluating add-on use of spironolactone in patients with resistant hypertension. Only randomized controlled trials determining antihypertensive effects of spironolactone were considered.Results The antihypertensive effects were assessed in 869 patients included in 4 trials with a mean follow-up of 12±3weeks. The reduction of systolic blood pressure (SBP) and diastolic BP (DBP) in patients treated with spironolactone was greater than placebo (weighted mean differences (WMD) for SBP -16.67mmHg (95% confidence interval (CI), -27.54, -5.80), p<0.01; WMD for DBP -6.11mmHg (95% CI, -9.34, -2.88), p<0.001), respectively. The rates of serious adverse effects or patient withdrawals from the trials tended to be higher in patients treated with spironolactone than placebo (WMD for odds ratio 2.11 (95% CI, 0.98, 4.53), p=0.05).Conclusions This meta-analysis provides the evidence that add-on use of spironolactone in patients with resistant hypertension is effective in lowering SBP and DBP, suggesting an add-on use of spironolactone as fourth line therapy in patients with resistant hypertension.
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Recent reports document the efficacy of mineralocorticoid receptor blockade to improve BP in patients with resistant hypertension.
“Recent reports document the efficacy of mineralocorticoid receptor blockade (Figure 3, step 3, and Table 4) to improve BP in patients with RH.373–377”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [374]
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References 40 · Cited by 60
- Authors
- Zhao, D., Liu, H., Dong, P., & Zhao, J.
- Affiliations
- Henan University of Science and Technology (CN)
- Luoyang Central Hospital Affiliated to Zhengzhou University (CN)
- Corresponding author
- Zhao, Di
- Venue
- International Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 233
- Pages
- 113-117
- ISSN
- 0167-5273 (ISSN-L)
- OpenAlex
- W2565616619
- Cited by
- 60
- References
- 40
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 4 · 2023: 6 · 2022: 7 · 2021: 3 · 2020: 10 · 2019: 11 · 2018: 8 · 2017: 1
- FWCI
- 1.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology
- Luoyang Central Hospital Affiliated to Zhengzhou University
- 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, adjunctive therapy, antihypertensive effect, blood pressure reduction, adverse effects
- MeSH terms
- Antihypertensive Agents, Blood Pressure, Diuretics, Humans, Hypertension, Spironolactone
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