Spironolactone versus nifedipine in essential hypertension

In a double-blind, randomized, multicenter study of 194 patients with moderate hypertension, spironolactone and nifedipine were found to reduce blood pressure (BP) to about the same extent and in the same percentage of patients after 45 days of treatment (47 and 50%, respectively). At that point, the patients controlled by either drug continued on their regimen for another 45 days, while patients whose BP was still elevated (diastolic BP greater than 90 mm Hg), received the other drug in addition. After 45 days of combination therapy, 63% of the patients had normal BP, whereas those receiving monotherapy largely remained normotensive (96% in the spironolactone group and 88% in the nifedipine group). The adverse effects were not severe with either group, but the incidence was markedly higher in the nifedipine group.