Philip A Kithas1, Mark A Supiano. 1. 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
Abstract
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.
RCT Entities:
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.
Authors: Denis L Clement; Marc L De Buyzere; Dirk A De Bacquer; Peter W de Leeuw; Daniel A Duprez; Robert H Fagard; Peter J Gheeraert; Luc H Missault; Jacob J Braun; Roland O Six; Patricia Van Der Niepen; Eoin O'Brien Journal: N Engl J Med Date: 2003-06-12 Impact factor: 91.245
Authors: William B White; Daniel Duprez; Richard St Hillaire; Scott Krause; Barbara Roniker; Janice Kuse-Hamilton; Michael A Weber Journal: Hypertension Date: 2003-04-07 Impact factor: 10.190
Authors: Bertram Pitt; Willem Remme; Faiez Zannad; James Neaton; Felipe Martinez; Barbara Roniker; Richard Bittman; Steve Hurley; Jay Kleiman; Marjorie Gatlin Journal: N Engl J Med Date: 2003-03-31 Impact factor: 91.245
Authors: Aram V Chobanian; George L Bakris; Henry R Black; William C Cushman; Lee A Green; Joseph L Izzo; Daniel W Jones; Barry J Materson; Suzanne Oparil; Jackson T Wright; Edward J Roccella Journal: Hypertension Date: 2003-12-01 Impact factor: 10.190
Authors: Ramachandran S Vasan; Jane C Evans; Martin G Larson; Peter W F Wilson; James B Meigs; Nader Rifai; Emelia J Benjamin; Daniel Levy Journal: N Engl J Med Date: 2004-07-01 Impact factor: 91.245
Authors: Raymond R Townsend; Ian B Wilkinson; Ernesto L Schiffrin; Alberto P Avolio; Julio A Chirinos; John R Cockcroft; Kevin S Heffernan; Edward G Lakatta; Carmel M McEniery; Gary F Mitchell; Samer S Najjar; Wilmer W Nichols; Elaine M Urbina; Thomas Weber Journal: Hypertension Date: 2015-07-09 Impact factor: 10.190
Authors: Annayya R Aroor; Vincent G Demarco; Guanghong Jia; Zhe Sun; Ravi Nistala; Gerald A Meininger; James R Sowers Journal: Front Endocrinol (Lausanne) Date: 2013-10-29 Impact factor: 5.555