A meta-analysis of add-on use of spironolactone in patients with resistant hypertension

Objective: The efficacy of add-on use of spironolactone in patients with resistant hypertension has been investigated in several small studies. We performed this meta-analysis evaluating the efficacy of add-on use of spironolactone in these patients. Methods: We searched Pubmed, Web of Science, and Cochrane Central for all published studies evaluating add-on use of spironolactone in patients with resistant hypertension. Only randomized controlled trials determining antihypertensive effects of spironolactone were considered. Results: The antihypertensive effects were assessed in 869 patients included in 4 trials with a mean follow-up of 12 +/- 3 weeks. The reduction of systolic blood pressure (SBP) and diastolic BP (DBP) in patients treated with spironolactone was greater than placebo (weighted mean differences (WMD) for SBP-16.67mmHg (95% confidence interval (CI), -27.54, -5.80), p < 0.01; WMD for DBP-6.11mmHg (95% CI, -9.34, -2.88), p < 0.001), respectively. The rates of serious adverse effects or patient withdrawals from the trials tended to be higher in patients treated with spironolactone than placebo (WMD for odds ratio 2.11 (95% CI, 0.98, 4.53), p = 0.05). Conclusions: This meta-analysis provides the evidence that add-on use of spironolactone in patients with resistant hypertension is effective in lowering SBP and DBP, suggesting an add-on use of spironolactone as fourth line therapy in patients with resistant hypertension. (C) 2017 Elsevier Ireland Ltd. All rights reserved.