Spironolactone will be used more for hypertension.
It's already commonly used for heart failure...but experts now realize it can also be effective for resistant hypertension.
About 10% of hypertension patients are considered resistant...because they require more than 3 drugs to control blood pressure.
Spironolactone is often added to a thiazide diuretic and ACE inhibitor or angiotensin receptor blocker.
It further suppresses the renin-angiotensin system by blocking aldosterone. Up to 10% of patients with hypertension have elevated levels of aldosterone.
Physicians start with low doses for hypertension...just 12.5 to 50 mg/day.
Recommend monitoring serum potassium and renal function.
Spironolactone can cause hyperkalemia...especially in patients with decreased renal function, diabetes, or severe heart failure.
Watch for patients who get spironolactone along with other drugs that increase potassium...ACE inhibitors, ARBs, or other potassium-sparing diuretics. Alert the patient and/or physician to keep an eye on the potassium level.
Am J Hypertens 2003;16:925.