Spironolactone and hydrochlorothiazide decrease vascular stiffness and blood
pressure in geriatric hypertension.
Author(s): Kithas PA, Supiano MA.
Affiliation(s): Geriatric Research, Education, and Clinical Center, George E. Wahlen Department
of Veterans Affairs Medical Center, 500 Foothill Drive (182), Salt Lake City, UT
84148, USA. Philip.Kithas@va.gov
Publication date & source: 2010, J Am Geriatr Soc. , 58(7):1327-32
OBJECTIVES: To determine the efficacy of spironolactone (SPIRO) and
hydrochlorothiazide (HCTZ) as monotherapy in older patients with hypertension in
blood pressure (BP) control and measures of vascular stiffness.
DESIGN: Randomized double-blind trial.
SETTING: University teaching hospital.
PARTICIPANTS: Forty-five subjects with hypertension (24 men, 21 women, mean age
69).
INTERVENTION: Six months of HCTZ (n=21) or SPIRO (n=24) therapy titrated to a
target systolic BP (SBP) less than 140 mmHg.
MEASUREMENTS: Baseline (after 4 weeks of antihypertensive drug washout) and
6-month 24-hour ambulatory BP data were obtained. Pulse pressure (PP) was
calculated as the difference between 24-hour average SBP and DBP. Pulse wave
velocity (PWV) was determined according to noninvasive recordings of carotid and
femoral artery pulse waves.
RESULTS: Six months of HCTZ and SPIRO treatment was associated with significant
decreases in 24-hour and nocturnal SBP and diastolic BP (DBP) (analysis of
variance (ANOVA) P<.001). At 6 months, average 24-hour and nocturnal SBP were
lower in the SPIRO than the HCTZ group (P<.001). PP and PWV also decreased
significantly with HCTZ and SPIRO treatments (ANOVA P<.001).
CONCLUSIONS: Six months of therapy with HCTZ or SPIRO resulted in comparable
reductions in 24-hour average and nocturnal SBP and DBP, PP, and PWV in older
subjects with hypertension.
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