Spironolactone in the treatment of hypertension: A neglected molecule

Abstract

Spironolactone, a mineralocorticoid receptor antagonist, is used in the treatment of hypertension for over 50 years. Due to the absence of morbidity and mortality studies, it is not considered to be a first-choice drug in the treatment of patients with primary hyperaldosteronism. However, it has a secure and stable position in the treatment of resistant hypertension. The effect of spironolactone on blood pressure lowering in antihypertensive combination therapy was demonstrated in several uncontrolled trials. The analysis of ASCOTBPLA study also contributed significantly to this area. In the last 10 years, the higher antihypertensive effect of spironolactone compared to placebo (ASPIRANT) and other antihypertensive drugs (PATHWAY-2) was proved in several randomized studies. The outcomes of morbidity and mortality studies in patients with chronic heart failure are also important for the clinical use of spironolactone in patients with hypertension - spironolactone reduces morbidity and mortality in patients with reduced ejection fraction and morbidity only in patients with normal ejection fraction. The outcomes of above-mentioned clinical studies are reflected in current guidelines in which spironolactone has an indisputable role in the treatment of resistant hypertension, primary hyperaldosteronism, and heart failure with reduced ejection fraction.