Zhongguo quanke yixue (Mar 2022)
Efficacy and Safety of Spironolactone in the Treatment of Resistant Hypertension：a Meta-analysis
Abstract
BackgroundAs a special type of hypertension, resistant hypertension has complex etiology, is difficult to treat, and more likely to lead to target organ damage. Recent studies have found that common triple combination antihypertensive therapies plus low-dose spironolactone could effectively control blood pressure in patients with resistant hypertension, but the efficacy and safety of such treatments need to be further verified due to small scales of these studies.ObjectiveTo perform a systematical review of the efficacy and safety of spironolactone for resistant hypertension.MethodsRandomized controlled trials (RCTs) on spironolactone for resistant hypertension were identified in databases of PubMed, Web of Science, The Cochrane Library, CNKI, VIP, and WanFang Date from inception to May 3rd, 2021. Two researchers separately screened the RCTs, extracted data and assessed the risk bias of eligible studies. Meta-analysis was conducted using RevMan 5.3.ResultsTwenty RCTs were included, nine of which did not report randomization methods, one used randomization based on the sequence of numbers including odd and even numbers of admission (pseudo-randomization) , seven did not report whether blinding was used, four were open-labeled, three described allocation concealment, and one had no complete results with no safety parameters for post-treatment of the controls. Meta-analysis revealed that compared to placebo and blank control groups, spironolactone-treated group had much lower clinic blood pressure, 24-hour ambulatory blood pressure (ABP) , daytime blood pressure and nighttime blood pressure (P<0.05) . Compared with patients treated with other antihypertensive drugs, spironolactone-treated patients had notably lower clinic systolic blood pressure (SBP) , 24-hour ABP, daytime SBP, nighttime SBP and self-measured home SBP (P<0.05) . Compared with those treated with renal nerve denervation, spironolactone-treated patients had significantly reduced daytime blood pressure and nighttime SBP (P<0.05) .In terms of safety, compared with those treated with placebo, spironolactone-treated patients had elevated serum potassium and creatinine (P<0.05) . Compared with patients treated with other antihypertensive drugs, spironolactone-treated patients had elevated serum potassium level (P<0.05) . Compared with those with renal nerve denervation, spironolactone-treated patients had elevated serum creatinine level (P<0.05) .ConclusionComparatively speaking, spironolactone is effective and safe for resistant hypertension. Due to limited quantity and quality of included studies, the conclusion still needs to be further verified by more high-quality studies.
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