Low-dose spironolactone helps regulate blood pressure in primary aldosteronism

Treatment with spironolactone at low doses helps improve blood pressure control in patients with primary aldosteronism, with the added benefit of reduced adverse effects, as shown in a retrospective study.

Researchers reviewed the medical records of 394 patients with primary aldosteronism receiving spironolactone. These patients were grouped into two, according to the median prescribed dose (50 mg): those treated with doses ≤50 mg (low-dose group) and those treated with doses >50 mg (high-dose group).

Outcomes included arterial blood pressure control, potassium levels, and the incidence of drug-related adverse effects.

Over a median follow-up of 12 months after the introduction of spironolactone, patients in the low-dose group received a higher number of antihypertensive drugs, especially diuretics, compared with those in the high-dose group. Blood pressure control, potassium and renin levels, and the occurrence of cardiovascular events at follow-up were similar between the low- and high-dose spironolactone groups.

Adverse effects were documented in 128 patients, with a higher proportion of men than women (44.7 percent vs 15.7 percent). The most common adverse effect was gynecomastia, followed by sexual dysfunction.

Adverse effects occurred less frequently in patients in the low- vs high-dose spironolactone group (39.1 percent vs 29.3 percent). This effect was pronounced only in men (p=0.002).

The findings may inform clinicians when choosing the best therapeutic option for each patient.