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Efficacy of low dose spironolactone in chronic kidney disease with resistant hypertension

Rozita Abolghasmi1, Omolbanin Taziki

  • 1Nephrology Department, Shahid Beheshti University of Medical Science, Imam Hosein Hospital, Tehran, Iran. yasnas54@yahoo.com

Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia
|January 4, 2011
PubMed

Insights

Adding low-dose spironolactone significantly reduced blood pressure in patients with chronic kidney disease (CKD) and resistant hypertension. This antihypertensive benefit was sustained over 12 weeks with minimal side effects.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Resistant hypertension is common in patients with chronic kidney disease (CKD).
  • Standard multi-drug regimens often fail to control blood pressure in these patients.
  • CKD patients with resistant hypertension require additional therapeutic strategies.

Purpose of the Study:

  • To evaluate the antihypertensive efficacy of low-dose spironolactone in patients with moderately severe CKD and resistant hypertension.
  • To assess the additive blood pressure-lowering effect of spironolactone in patients already on a diuretic, calcium channel blocker, and ACE inhibitor/ARB.
  • To determine the safety and tolerability of low-dose spironolactone in this patient population.

Main Methods:

  • A randomized controlled trial was conducted with 41 patients with CKD (GFR 25-50 mL/min) and resistant hypertension.
  • Patients were randomly assigned to receive either low-dose spironolactone (25-50 mg/day) or a placebo.
  • Blood pressure was monitored at baseline, 6 weeks, and 12 weeks. Serum potassium levels were also assessed.

Main Results:

  • Spironolactone addition resulted in a significant mean decrease in systolic blood pressure of 33 mmHg at 6 weeks and 36 mmHg at 12 weeks.
  • Diastolic blood pressure decreased by 13 mmHg at 6 weeks and 12 mmHg at 12 weeks in the spironolactone group.
  • No significant blood pressure changes were observed in the placebo group. One patient in the spironolactone group experienced hyperkalemia.

Conclusions:

  • Low-dose spironolactone provides a significant additive blood pressure reduction in CKD patients (stage 2 and 3) with resistant hypertension.
  • Spironolactone is an effective and generally well-tolerated option for managing resistant hypertension in this population.
  • Further research may explore optimal dosing and long-term outcomes of spironolactone in CKD patients.

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