Comparison of Surgery and Prolonged Spironolactone Therapy in Patients with Hypertension, Aldosterone Excess, and Low Plasma Renin

Abstract

SummaryThe effect of prolonged preoperative treatment with spironolactone has been studied in a series of 67 patients with hypertension, aldosterone excess, and low plasma renin. In the series as a whole a highly significant reduction in both systolic and diastolic pressures was achieved, with no evidence of escape from control during therapy lasting several years in some cases. The drug was equally effective in controlling blood pressure in patients with and without adrenocortical adenomata. Occasional unresponsive patients were encountered in both groups; pretreatment blood urea levels in these were significantly higher than in the responsive patients. The hypotensive effect of spironolactone usually predicted the subsequent response to adrenal surgery.Spironolactone in all cases corrected plasma electrolyte abnormalities; significant increases in total exchangeable (or total body) potassium and significant reductions in total exchangeable sodium, total body water, extracellular fluid, and plasma volumes were seen. Plasma urea rose during treatment and there was a slight fall in mean body weight. Significant increases in peripheral venous plasma renin and angiotensin II concentrations occurred during treatment.In two patients no increase in aldosterone secretion rate was found during treatment, although plasma aldosterone rose in three of four subjects studied. Severe side effects were rare; in only two of the 67 patients did the drug have to be stopped.

Clinical and biochemical effects of spironolactone administered once daily in primary hypertension. Multicenter Sweden study.

“…The endocrine effects seemed related to the dose, as previously reported. 40 - 41 However, only two patients were withdrawn from this study due to side effects.…”

Effect of Spironolactone on Blood Pressure in Subjects With Resistant Hypertension

“…[3][4][5][6][7][8][9][10][11] Small uncontrolled studies have also demonstrated its effectiveness in patients with resistant hypertension. [12][13][14][15] This is reflected in the latest British Hypertension Society guidelines, which recommend spironolactone as fourth-line therapy when other drugs have failed to control BP.…”

Clinical implications of primary aldosteronism with resistant hypertension.

“…The predictive value of spironolactone in indicating the likely hypotensive effect of adrenal surgery was emphasized by Brown et al 2 In that study, however, the drug was equally effective in controlling arterial pressure in patients with and without adenomas, although in the latter, arterial pressure rarely responds favorably to adrenal surgery. In a similar study" we showed that any measure reducing plasma volume in patients with primary aldosteronism (whether by sodium deprivation or combining hydrochlorothiazide with small doses of spironolactone) resulted in normalization of arterial pressure.…”