Spironolactone for the treatment of isolated systolic hypertension

Treatment of ISH is effective in the prevention of congestive heart failure and cerebrovascular accidents, however control of ISH usually requires combination therapy is often difficult with only 50% of patients controlled. Method: Escribe, (Lille Corp, Albany, New York), our electronic record company, provided a list of all patients in the practice that had spironolactone on their medication list. A retrospective chart review of these patients was performed and only data from patients that were on spironolactone for hypertension treatment was collected. Office blood pressures (BP) were averaged from 1-3 visits before treatment with spironolactone (pre-spiro) and after the addition of spironolactone (postspiro). The office BP reflected the usual clinical practice of BP measurement, however was not performed in a standard manner. Results: Forty-eight patients were identified, with an average age 71.6 10.1 years and a pre-spiro BP of 157.7 16.4/74.5 11.8mmHg. Post-spiro BP was 141.7 19.5/70.6 12.6mmHg (p 0.05 for both SBP and DBP). The addition of spironolactone decreased the BP by 15.9/ 3.8mmHg (p 0.05). This group was sub-divided into spironolactone responders ( 10mmHg decrease in SBP) and non-responders ( 10mmHg decrease in SBP). There were 33 responders (69%) and 15 non-responders (31%) with similar average ages in both groups. The addition of spironolactone decreased the BP by 25.3/8.1mmHg for the responders and 0.6/ 0.1mmHg for the non-responders (P 0.05 for both SBP and DBP). There were no significant differences (p 0.05) between the responders and non-responders for the drugs before or after the addition of spironolactone, number of visits before or after spironolactone, or number of patients on ACE inhibitors, angioreceptor blockers, calcium channel blockers, beta-blockers, or other drug categories. Conclusions: Spironolactone may be effective for treatment of isolated systolic hypertension, however a randomized, controlled trial using spironolactone or eplerenone should be considered.