More evidence for spironolactone for resistant hypertension

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More evidence for spironolactone for resistant hypertension 

A systematic review of 12 trials1 found that spironolactone reduced the office systolic blood pressure by an average of 20.12 mm Hg 5.73 mm Hg diastolic. On the 24-hour assessment, there was a reduction of 10.31 mm Hg.

Treatment-resistant hypertension was described as “the inability to reach standard BP levels (below 140/90 mm Hg) despite the concurrent use of 3 or more antihypertensive agents of different classes that include at least one kind of diuretic is defined as resistant hypertension”.

Spironolactone is very effective but a difficult medication to use. It can cause GI disturbances, as well as breast pain and enlargement in men. There is a safety issue and monitoring of serum potassium needs to be done within days of starting and regularly thereafter. In Europe, it is a 4th line drug but in New Zealand, a 5th line after betablockers.


  1. Clinical efficacy and safety of spironolactone in patients with resistant hypertension. Medicine (2020) View here

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

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