Spironolactone for difficult to control hypertension in chronic kidney disease: an analysis of safety and efficacy
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Published on: July 3, 2013
Jodi Heshka1, Marcel Ruzicka, Swapnil Hiremath
1Department of Medicine, University of Ottawa, Ottawa, Ontario.
Insights
Spironolactone effectively lowers blood pressure in patients with difficult-to-control hypertension, including those with chronic kidney disease (CKD). While it can increase potassium levels, especially in severe CKD, it remains a viable treatment option.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Spironolactone is a known antihypertensive agent.
- Its safety and efficacy in patients with chronic kidney disease (CKD) and resistant hypertension are not well-established.
- Difficult-to-control hypertension poses significant cardiovascular risks.
Purpose of the Study:
- To evaluate the effectiveness and safety of spironolactone in patients with difficult-to-control hypertension and CKD.
- To compare the blood pressure response and biochemical changes in CKD patients versus non-CKD patients treated with spironolactone.
Main Methods:
- Retrospective cohort study.
- Involved 88 patients with difficult-to-control hypertension.
- Assessed blood pressure response and serum potassium levels before and after spironolactone initiation.
Main Results:
- Spironolactone significantly reduced systolic blood pressure (SBP) in both CKD (153 to 143 mm Hg) and non-CKD (150 to 135 mm Hg) groups.
- SBP decreased by >10 mm Hg in 44% of CKD patients and 59% of non-CKD patients.
- Serum potassium increased by 0.5 mmol/L in CKD patients and 0.3 mmol/L in non-CKD patients, with a 5.7% incidence of hyperkalemia in the CKD group.
Conclusions:
- Spironolactone is effective in lowering blood pressure in patients with difficult-to-control hypertension, even in the presence of CKD.
- A modest increase in serum potassium is observed, particularly in patients with a glomerular filtration rate below 45 mL/minute.
- Careful monitoring of potassium levels is recommended when using spironolactone in CKD patients.
Abstract:
Spironolactone is effective at treating difficult to control hypertension in the general population, and it is unknown if it is safe or effective for those with chronic kidney disease (CKD) and difficult-to-control hypertension. In a retrospective cohort design, 88 patients with difficult-to-control hypertension study were assessed for blood pressure (BP) response to spironolactone as well as for biochemical changes. In the CKD group (34 patients), the average systolic BP (SBP) fell from 153 ± 18 to 143 ± 20 mm Hg (P = .006) compared with a fall in SBP from 150 ± 17 to 135 ± 17 mm Hg (P < .0001) in the non-CKD group (P < .0001). In 44% of those with CKD and 59% of those without CKD, SBP decreased by >10 mm Hg (defined as responders; P = .22). Potassium rose by 0.5 ± 0.6 mmol/L in the CKD group and 0.3 ± 0.5 mmol/L in the non-CKD group (P = .12). The overall incidence of hyperkalemia was 5.7% in the CKD group and 0% in the non-CKD group (P = .07). Spironolactone is associated with a significant fall in BP among those with CKD and difficult-to-control BP. It is associated with a modest rise in serum potassium, which is more pronounced among those with glomerular filtration rate below 45 mL/minute.
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