Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(3):384-390 | DOI: 10.5507/bp.2012.105

Effect of spironolactone in patients with resistant arterial hypertension in relation to age and sex: Insights from the aspirant trial

Jan Vaclavik^a, Richard Sedlak^b, Jiri Jarkovsky^c, Eva Kocianova^a, Milos Taborsky^a

^a Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic

^b Department of Internal Medicine, Prostejov Hospital, Prostejov

^c Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Science, Masaryk University, Brno

Background: There are currently limited data on whether the effect of spironolactone in patients with resistant arterial hypertension depends on age and sex.

Methods: Patients with an office systolic blood pressure (BP) >140 mmHg or diastolic BP >90 mmHg, despite treatment with at least 3 antihypertensive drugs including a diuretic, were randomly assigned to receive spironolactone or a placebo for 8 weeks in a double-blind, placebo-controlled, multicentre trial (ASPIRANT).

Results: Analyses were done on 55 patients treated with spironolactone and 56 patients treated with placebo. Significant reductions of office systolic BP (-8.9 ± 6.7 mmHg, P=0.012), 24-h ABPM systolic BP (-7.9 ± 7.2 mmHg, P=0.032) and ABPM day-time systolic BP (-7.5 ± 7.1 mmHg) after 8 weeks of spironolactone treatment, compared to placebo, were only observed in patients with a median age >62 years. The office and ABPM systolic BP reductions in patients aged ≤62 years and diastolic BP reductions by spironolactone in both age groups were not significant compared to placebo. Women tended to have a nonsignificantly higher reduction in systolic BP with spironolactone treatment, and there was no difference in diastolic BP reduction between women and men.

Conclusions: Spironolactone only leads to a reduction of systolic BP in older patients with resistant arterial hypertension aged >62 years, and is effective to a similar extent in men and women.

Keywords: resistant hypertension, spironolactone, blood pressure, age, sex

Received: April 10, 2012; Accepted: November 27, 2012; Prepublished online: December 7, 2012; Published: September 30, 2014  Show citation