This Article Full Text Full Text (PDF) All Versions of this Article: 50/3/e57    most recent HYPERTENSIONAHA.107.092767v1 Alert me when this article is cited Alert me if a correction is posted 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 Feely, J. Articles by Mahmud, A. Search for Related Content PubMed PubMed Citation Articles by Feely, J. Articles by Mahmud, A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information High Blood Pressure Hazardous Substances DB SPIRONOLACTONE Related Collections Other hypertension Clinical Studies Other etiology

(Hypertension. 2007;50:e57.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Spironolactone in Resistant Hypertension

Department of Therapeutics and Hypertension Clinic, St. James’s Hospital, Dublin, Ireland

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

To the Editor:

The recent article by Chapman¹ and the accompanying editorial by Goodfriend² provide an evidence base for an increased use of spironolactone in patients with resistant hypertension. The usual definition of resistant hypertension states that a diuretic should have been included in the regimen of 3 or more drugs. In this Anglo-Scandinavian Cardiac Outcomes Trial subgroup it appears that less than half the subjects defined as being resistant had been exposed to diuretics and their response to spironolactone was not different. It may no longer be necessary to have prior thiazide use to define "resistant" hypertension in Caucasians patients.

Why twice as many of those receiving atenolol-diuretic with potassium regimen compared with amlodipine-perindopril regimen received spironolactone is not explained.

Was there a difference in the percentage with resistant hypertension? It would be helpful if the pre- and postspironolactone treatment BP data for both amlodipine and atenolol based groups was presented separately. As spironolactone is not licensed in the UK, was there a difference between the prevalence of its use in the "Anglo" and Scandinavian populations?

An interesting finding is those with the lowest potassium or greatest potassium increase showed a greater BP response. We³ have previously shown, albeit in a much smaller study, a significantly greater BP reduction to spironolactone 50 mg daily in resistant hypertension in individuals with potassium of under as opposed to over 4 mmol/L.

Goodfriend² offered a number of possible reasons for the remarkable hypotensive response to spironolactone. Given the preferential reduction in systolic . . . [Full Text of this Article]

This article has been cited by other articles:

				N. Chapman, J. Dobson, S. Wilson, B. Dahlof, P. S. Sever, H. Wedel, and N. R. Poulter Response to Spironolactone in Resistant Hypertension Hypertension, September 1, 2007; 50(3): e58 - e58. [Full Text] [PDF]