Spironolactone ok for hypertension but not diastolic dysfunction

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Goodfellow Gems

"Spironolactone ok for hypertension but not diastolic dysfunction"

I recall a woman in her 40’s with a very high blood pressure (230/120) and nothing shifted it – she was on a diuretic, ACE, calcium channel blocker and a betablocker. She had some hirsuitism and I tried some spironolactone- 25 mg daily. She came back for the next visit and her BP was 120/80. I was using an electronic blood pressure machine and we both saw the result and gasped. This worked for a number of years after which she stopped it due to not feeling well – a common experience for patients on spironolactone and there is some evidence about more gastrointestinal upset. Spironolactone has been shown to be effective in hypertension in a Cochrane review. They suggested using doses of 25 mg to 50 mg.1

A recent trial of spironolactone 15 mg to 45 mg per day was not effective in patients with diastolic dysfunction congestive heart failure (now called heart failure with preserved left ventricular ejection fraction – a more descriptive term and requires an echocardiogram to make the diagnosis). This is unfortunate as there don’t seem to be any effective treatments for this common form of congestive heart failure.

Caution is needed with using spironolactone with other medications which elevate serum potasissium (e.g ACE or angiotensin blockers) and in all usage close monitoring of K+ is needed especially when starting. It should not be used when the serum creatinine is > 220 micromol/L or when the serum K+ is > 5.0 millimol/L.2

  1. Spironolactone for hypertension. Cochrane review. DOI: 10.1002/14651858.CD008169.
  2. N Engl J Med. 2014 Apr 10;370(15):1383-92. doi: 10.1056/NEJMoa1313731.

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 04/02/2015