AIMS/HYPOTHESIS: Aldosterone antagonism improves endothelial function (and reduces deaths) in chronic heart failure. It is not known whether similar effects occur in other high-risk groups such as patients with diabetes and hypertension. We therefore assessed the full effects of aldosterone blockade in poorly controlled hypertensive patients with type 2 diabetes, focussing on blood pressure, endothelial function, glycaemic control and key hormones. METHODS: We performed a randomised, placebo-controlled, double-blind, crossover study on 50 patients with type 2 diabetes and treated but poorly controlled hypertension, comparingspironolactone versus placebo. Patients had their endothelial function assessed by standard forearm venous occlusion plethysmography. RESULTS: There was no significant improvement in endothelium-dependent vasodilatation in response to acetylcholine, despite highly significant reductions in systolic and diastolic blood pressure. However, spironolactone significantly worsened glycaemic control, plasma angiotensin II and cortisol. CONCLUSIONS/ INTERPRETATION:Spironolactone is highly effective in lowering blood pressure in patients with type 2 diabetes and poorly controlled hypertension on standard treatment, but does not improve vascular endothelial function in this group. We speculate that any tendency for the spironolactone-induced lowering of blood pressure to improve endothelial function is offset by its tendency to worsen glycaemic control and increase the levels of angiotensin II and even possibly cortisol.
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AIMS/HYPOTHESIS: Aldosterone antagonism improves endothelial function (and reduces deaths) in chronic heart failure. It is not known whether similar effects occur in other high-risk groups such as patients with diabetes and hypertension. We therefore assessed the full effects of aldosterone blockade in poorly controlled hypertensivepatients with type 2 diabetes, focussing on blood pressure, endothelial function, glycaemic control and key hormones. METHODS: We performed a randomised, placebo-controlled, double-blind, crossover study on 50 patients with type 2 diabetes and treated but poorly controlled hypertension, comparing spironolactone versus placebo. Patients had their endothelial function assessed by standard forearm venous occlusion plethysmography. RESULTS: There was no significant improvement in endothelium-dependent vasodilatation in response to acetylcholine, despite highly significant reductions in systolic and diastolic blood pressure. However, spironolactone significantly worsened glycaemic control, plasma angiotensin II and cortisol. CONCLUSIONS/ INTERPRETATION:Spironolactone is highly effective in lowering blood pressure in patients with type 2 diabetes and poorly controlled hypertension on standard treatment, but does not improve vascular endothelial function in this group. We speculate that any tendency for the spironolactone-induced lowering of blood pressure to improve endothelial function is offset by its tendency to worsen glycaemic control and increase the levels of angiotensin II and even possibly cortisol.
Authors: H Kawano; T Motoyama; O Hirashima; N Hirai; Y Miyao; T Sakamoto; K Kugiyama; H Ogawa; H Yasue Journal: J Am Coll Cardiol Date: 1999-07 Impact factor: 24.094
Authors: J M Luther; P Luo; M T Kreger; M Brissova; C Dai; T T Whitfield; H S Kim; D H Wasserman; A C Powers; N J Brown Journal: Diabetologia Date: 2011-04-26 Impact factor: 10.122
Authors: Paweena Susantitaphong; Kamal Sewaralthahab; Ethan M Balk; Somchai Eiam-ong; Nicolaos E Madias; Bertrand L Jaber Journal: Am J Hypertens Date: 2013-01-07 Impact factor: 2.689