Spironolactone and chlorthalidone in uncontrolled elderly hypertensive patients treated with calcium antagonists and angiotensin ii receptor-blocker: Effects on endothelial function, inflammation, and oxidative stress

Hiroshi Yamanari, Kazufumi Nakamura, Daiji Miura, Shuichi Yamanari, Tohru Ohe

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

The side effects of thiazide-type diuretics include metabolic abnormality and increased oxidative stress, which might cause endothelial dysfunction despite blood pressure reduction. In hypertensive patients with heart failure, treatment with an aldosterone antagonist resulted in improvements in endothelial function and significant blood pressure reduction. The purpose of the present study was to evaluate the differences between spironolactione and chlorthalidone in hypertensive elderly patients treated with calcium antagonists and angiotensin II receptor blockers. Fourteen uncontrolled hypertensive patients treated with amlodipine and candesartan were included in this study. The study was an open-label randomized crossover comparison of 16 weeks treatment with spironolactone against chlorthalidone added to amlodipine and candesartan. blood pressure significantly decreased in patients treated with both spironolactone and chlorthalidone. Chlortalidone reduced flowmediated dilation significantly compared to the baseline condition and spironolactone. serum highsensitively C-reactive protein and uric acid increased significantly in chlorthalidone- treated patients compared to spironolactonetreated patients. We conclude that spironolactone may be a more useful add-on therapy than chlorthalidone in hypertensive patients inadequately controlled on candesartan and amlodipine, because spironolactone preserves endothelial function and reduces inflammation compared to chlorthalidone.

Original languageEnglish
Pages (from-to)585-594
Number of pages10
JournalClinical and Experimental Hypertension
Volume31
Issue number7
DOIs
Publication statusPublished - Nov 2009

Keywords

  • Chlorthalidone
  • Elderly hypertension
  • Endothelial function
  • Inflammation
  • Spironolactone

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology

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