Clinical efficacy of spironolactone for resistant hypertension: a meta analysis from randomized controlled clinical trials

Objectives: This study sought to determine the current effectiveness and safety of spironolactone for resistant hypertension. Methods: Pubmed, EMBASE and Cochrane databases were searched to identify studies that used spironolactone as add-on treatment in resistant hypertension patients. The major outcome is reduction of blood pressure. Results: Three randomized controlled trials, 5 observational study without control group have been identified. At follow-up review, there was a reduction in mean systolic and diastolic blood pressure (BP) respectively, of -20.56 mmHg (95% confidence interval [CI]: -36.47 to -4.65 mmHg) and -6.04 mm Hg (95% CI: -10.24 to -1.85 mm Hg) in controlled study. In uncontrolled studies, at 6-month follow-up, systolic and diastolic BP were reduced -20.73 mm Hg (95% CI: -25.62 to -15.83 mm Hg) and -8.94 mm Hg (95% CI: -10.82 to -7.05 mm Hg, respectively. Conclusion: Spironolactone resulted in the reduction of mean BP in patients with resistant hypertension. The sustained efficacy and safety of spironolactone need to further confirm by large randomized controlled trials with long-term follow-up.