This Article Full Text Full Text (PDF) All Versions of this Article: 49/4/763    most recent 01.HYP.0000259806.91169.01v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Goodfriend, T. L. Search for Related Content PubMed PubMed Citation Articles by Goodfriend, T. L. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information High Blood Pressure Hazardous Substances DB SPIRONOLACTONE Related Collections Obesity Cardiovascular Pharmacology Clinical Studies Related Article

(Hypertension. 2007;49:763.)
© 2007 American Heart Association, Inc.

Editorial Commentaries

Treating Resistant Hypertension With a Neglected Old Drug

Theodore L. Goodfriend

From the William S. Middleton Memorial Veterans Hospital and Departments of Medicine and Pharmacology, School of Medicine and Public Health, University of Wisconsin, Madison.

Correspondence to Theodore L. Goodfriend, Research Service, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terr, Madison, WI 53705. E-mail Theodore.goodfriend@med.va.gov

An extract of the first 250 words of the full text is provided, because this article has no abstract.

"Be Not Too Fast to Cast the Old Aside"^*

Hypertensive patients are said to be resistant to therapy when their pressures exceed goal despite treatment with 3 antihypertensive drugs. The tendency of most clinicians is to treat resistant patients with stronger and stronger agents in higher and higher doses. By contrast, a few reports in the literature suggest surprising usefulness of spironolactone, a relatively weak diuretic, in resistant hypertension.^1–6 In this issue of Hypertension, Chapman et al⁷ describe the largest reported cohort of resistant hypertensive subjects who responded to spironolactone. The average fall in blood pressure was 22/10 mm Hg on 25 mg per day, quite a noteworthy effect for a low dose of a reputedly feeble old agent, especially when added to 3 newer drugs with better reputations! What’s more, the resistant patients who responded to spironolactone included older subjects with predominantly systolic hypertension, many of whom were diabetic, a notoriously recalcitrant group.

Spironolactone antagonizes aldosterone and other salt-retaining steroids by competing for the mineralocorticoid receptor. This action is the simplest but not the only plausible explanation for the efficacy of spironolactone, and it implies that aldosterone plays an unusually prominent role in supporting the pressure of resistant patients. If aldosterone caused resistance, one might assume that those patients were producing a lot of it, but it is unlikely that a dose of 25 mg of spironolactone could have had dramatic effects as an aldosterone antagonist if the endogenous steroid levels were very high. Clinical experiments teach that . . . [Full Text of this Article]

Related Article:

Effect of Spironolactone on Blood Pressure in Subjects With Resistant Hypertension

Neil Chapman, Joanna Dobson, Sarah Wilson, Björn Dahlöf, Peter S. Sever, Hans Wedel, Neil R. Poulter on behalf of the Anglo-Scandinavian Cardiac Outcomes Trial Investigators
Hypertension 2007 49: 839-845. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				G. J. Becker, T. D. Hewitson, and A. Chrysostomou Aldosterone in clinical nephrology--old hormone, new questions Nephrol. Dial. Transplant., August 1, 2009; 24(8): 2316 - 2321. [Full Text] [PDF]

				J. R. Sowers, A. Whaley-Connell, and M. Epstein Narrative Review: The Emerging Clinical Implications of the Role of Aldosterone in the Metabolic Syndrome and Resistant Hypertension Ann Intern Med, June 2, 2009; 150(11): 776 - 783. [Abstract] [Full Text] [PDF]

				A. Delgado-Almeida Unexpected Therapeutic Response to Spironolactone: A Prospective Debate on Aldosterone and Potassium Ion in Hypertension Hypertension, November 1, 2007; 50(5): e165 - e164. [Full Text] [PDF]

				J. Feely and A. Mahmud Spironolactone in Resistant Hypertension Hypertension, September 1, 2007; 50(3): e57 - e57. [Full Text] [PDF]

				S. J. Hood, K. P. Taylor, M. J. Ashby, and M. J. Brown The Spironolactone, Amiloride, Losartan, and Thiazide (SALT) Double-Blind Crossover Trial in Patients With Low-Renin Hypertension and Elevated Aldosterone-Renin Ratio Circulation, July 17, 2007; 116(3): 268 - 275. [Abstract] [Full Text] [PDF]