부산대학교 도서관

Background: Spironolactone is an aldosterone antagonist, considered fourth line therapy for hypertension in patients already treated with multiple medications. Objectives: Primary: to determine the effect of spironolactone on patient mortality, morbidity, and to quantify the magnitude of blood pressure lowering effect of spironolactone monotherapy. Secondary: to determine the prevalence of adverse reactions observed with spironolactone monotherapy and to determine if there is a blood‐pressure lowering dose response with spironolactone. Search strategy: We searched the following databases: Cochrane Central Register of Controlled Trials (3rd Quarter 2009), MEDLINE (2005 ‐ Sept. 2009), and EMBASE (2007 ‐ Sept. 2009). References from retrieved studies were reviewed to identify any studies missed in the initial search. No language restrictions were applied. Selection criteria: We selected RCTs studying patients with primary hypertension. We excluded studies of patients with secondary or gestational hypertension, and studies where patients were receiving multiple antihypertensives. Data collection and analysis: Two reviewers independently reviewed the search results for studies meeting our criteria. Three reviewers extracted data and assessed trial quality using a standardized data extraction form. Data synthesis and analysis was performed using RevMan 5. Main results: Meta‐analysis of the 5 cross‐over studies found a reduction in SBP of 20.09 mmHg (95%CI:16.58‐23.06,p50mg/day do not produce further reductions in either SBP or DBP. One cross‐over study found that spironolactone 25 mg/day did not statistically significantly change SBP or DBP compared to placebo, SBP: ‐9.9 (95%CI:‐21.15,1.35); DBP ‐2.34 (95%CI:‐7.92,3.06). Authors' conclusions: From the limited available evidence, spironolactone appears to lower blood pressure compared to placebo to a similar degree in patients with primary (essential) hypertension when doses of 100‐500 mg/day are given. A dose of 25 mg/day did not statistically significantly reduce systolic or diastolic blood pressure, compared to placebo. Given the lack of a dose‐response, coupled with a possible increased risk in adverse events with higher doses, doses of 25 to 100 mg/day are reasonable. There is no evidence of the effect of spironolactone on clinical outcomes in hypertensive patients.