Resistant hypertension - spironolactone better than doxasosin or bisoprolol

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"Resistant hypertension: spironolactone better than doxasosin or bisoprolol"

This information comes from a cross-over clinical trial in patients with resistant hypertension (>140 systolic) after being on maximum ACE/ARB, calcium channel blocker and diuretic. They were randomised to placebo, spironolactone (25-50 mg), bisoprolol (5-10 mg) or doxazosin modified release (4-8 mg). The baseline systolic blood pressure was 157 in the office and 147.6 at home. The average reduction in home systolic blood pressure at 12 months on spironolactone was superior to placebo (-8.70 mm Hg [95% CI -9.72 to -7.69]; p<0.0001), superior to the mean of the other two active treatments (doxazosin and bisoprolol; -4.26 [-5.13 to -3.38]; p<0.0001). Six of 285 patients had a serum K+ of 6 mmol/l or greater on one occasion. It is important to monitor serum potassium when starting and changing doses with spironolactone. It is important to note that the outcomes here are blood pressure and not cardiovascular outcomes.



  1. Williams B, MacDonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet. 2015 Sep 18. pii: S0140-6736(15)00257-3.
    doi: 10.1016/S0140-6736(15)00257-3.PMID: 26414968

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.

As published in NZ Doctor 11/11/2015