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Spironolactone and Hydrochlorothiazide Decrease Vascular Stiffness and Blood Pressure in Geriatric Hypertension
Author(s) -
Kithas Philip A.,
Supiano Mark A.
Publication year - 2010
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2010.02905.x
Subject(s) - medicine , hydrochlorothiazide , pulse wave velocity , blood pressure , ambulatory blood pressure , arterial stiffness , diuretic , spironolactone , cardiology , ambulatory , pulse pressure , diastole , urology , heart failure
OBJECTIVES: To determine the efficacy of spironolactone (SPIRO) and hydrochlorothiazide (HCTZ) as monotherapy in older patients with hypertension in blood pressure (BP) control and measures of vascular stiffness. DESIGN: Randomized double‐blind trial. SETTING: University teaching hospital. PARTICIPANTS: Forty‐five subjects with hypertension (24 men, 21 women, mean age 69). INTERVENTION: Six months of HCTZ (n=21) or SPIRO (n=24) therapy titrated to a target systolic BP (SBP) less than 140 mmHg. MEASUREMENTS: Baseline (after 4 weeks of antihypertensive drug washout) and 6‐month 24‐hour ambulatory BP data were obtained. Pulse pressure (PP) was calculated as the difference between 24‐hour average SBP and DBP. Pulse wave velocity (PWV) was determined according to noninvasive recordings of carotid and femoral artery pulse waves. RESULTS: Six months of HCTZ and SPIRO treatment was associated with significant decreases in 24‐hour and nocturnal SBP and diastolic BP (DBP) (analysis of variance (ANOVA) P <.001). At 6 months, average 24‐hour and nocturnal SBP were lower in the SPIRO than the HCTZ group ( P <.001). PP and PWV also decreased significantly with HCTZ and SPIRO treatments (ANOVA P <.001). CONCLUSIONS: Six months of therapy with HCTZ or SPIRO resulted in comparable reductions in 24‐hour average and nocturnal SBP and DBP, PP, and PWV in older subjects with hypertension.