Spironolactone may treat hypertension

A drug that costs £1.50 a month and has been around for 50 years could revolutionise the care of patients with persistent high blood pressure.

Spironolactone was first used in 1959 as a water pill to treat fluid retention – but new findings show it also works in three out of five patients whose blood pressure is out of control.

Experts today said the finding offered hope of ‘spectacular’ cost savings.

An estimated 500,000 people have high blood pressure that does not respond to at least three types of medication, known as resistant hypertension.

People with high blood pressure are advised to change their lifestyle and eat less salt, lose weight, drink less alcohol, eat more fruit and vegetables and exercise more.

But six million Britons also take drugs to reduce their blood pressure, which raises the risk of early death, heart attacks and strokes.

The new study involved 335 patients who had uncontrolled blood pressure despite treatment with the maximum doses of three antihypertensive medicines.

The results show that 60 per cent of patients had their blood pressure controlled for the first time.

Spironolactone was three times more likely to work, when added to three existing pills, than two other types of drug added to the mix.

Findings from the study, funded by the British Heart Foundation charity, were released at the European Society of Cardiology Congress in London.

Study presenter Professor Bryan Williams, from University College London, said: ‘Spironolactone is overwhelmingly the most effective treatment for resistant hypertension.

‘When we look at the achieved blood pressure on these treatment options, the average home systolic blood pressure on spironolactone was 134.9 mm Hg, which is just below the target level of 135 mm Hg.

‘In other words, we were controlling a large percentage of these patients previously defined as [having] uncontrollable hypertension.’

The drug costs the NHS between £1.50 and £2.50 a month, depending on the dose.

Blood pressure
Blood pressure

Professor Williams said the drug offers a ‘spectacularly cost-effective approach’ in the UK and elsewhere, because it’s cheap and patients are at very high risk of suffering serious heart problems.

‘These people are at an especially high risk of cardiovascular events due to their long-term exposure to high blood pressure and the fact that many of them have other conditions such as diabetes and chronic kidney disease,’ he added.

He added that despite 50 years of research, there had been little progress in achieving the optimal drug treatment for resistant hypertension – but the ‘unequivocal’ trial findings should now lead to a re-writing of current guidelines and clinical practice.

Spironolactone, originally developed as a diuretic, to treat people who retain too much fluid, is currently used for heart failure and some liver and kidney conditions.

In the trial there were larger reductions in blood pressure for patients taking the drug in combination with three other medications, than for those trying two other drugs or a dummy pill.

Patients had their blood pressure measured at six and 12 weeks.

Professor Peter Weissberg, medical director of the British Heart Foundation, said it showed that inexpensive drugs which have been around for a long time are effective and safe for treating high blood pressure.

Because doctors are already familiar with the drug, he said, the findings ‘should lead rapidly’ to its everyday use in resistant hypertension and for hypertensive patients who may be at high risk of developing diabetes.

He said: ‘The results are hugely encouraging both for patient welfare and the NHS budget. We would expect medical guidelines across the world to change rapidly to reflect these results.’

High blood pressure and how to fight it

Not enough people understand how dangerous high blood pressure can be, and what can raise it significantly – like the affect of salt in your diet.

What is high blood pressure?

The force the blood puts on your blood vessel walls is called blood pressure. Weirdly we measure it in millimetres of mercury (mmHg) with normal blood pressure being 140/90 or less. The top number is called the systolic blood pressure and is the pressure reading taken when the heartbeats. The bottom number (doctors call this the diastolic) is the reading taken in between beats when the heart relaxes. Doctors call high blood pressure hypertension.

How does that compare to low blood pressure?

This is the opposite of the above where the pressure in the arteries is abnormally low. A reading less than 90/60 is by definition low. Doctors refer to low blood pressure as hypotension.

Is high blood pressure stress related?

Yes it can be. Stress revs us up and in doing so it can rev up our blood pressure because it causes us to release cortisol and adrenaline, which are our so-called “stress hormones”.

Can you inherit high blood pressure?

Yes. If you have a relative with high blood pressure you are more likely to suffer. Interestingly this is thought to be a combination of both genes and environment.

Can what you eat affect it?

Yes! Having too much salt in your diet can contribute to high blood pressure. This means you need to stop adding salt to you food. Not only this you also need to avoid processed foods as 3/4 of the salt in our diet is hidden in foods, e.g. microwave meals, canned foods and takeaways. Low fat diets, which are rich in fibre, vitamins and minerals, can also help to reduce blood pressure.

Be careful about drinks too as alcohol and caffeine can also contribute to elevations in blood pressure.

Can it give you a heart attack? Is it really that serious?

Yes, high blood pressure is serious. Just because it rarely produces symptoms doesn’t mean it doesn’t result in risk. Because the increased pressure puts strain on the blood vessels it can result in damage to the heart, ranging from a heart attack to angina and blocked arteries.

It can also damage your brain resulting in stroke or memory problems, your kidneys making them malfunction, your eyes resulting in impaired vision or even blindness and can even cause sexual dysfunction.

What can you use to monitor it? Do wrist monitors work?

You can have a blood pressure check. If you are over 40 you can have a NHS health check and also have your blood pressure and other risk factors checked. Your GP or practice nurse can also check your blood pressure. Many surgeries now have machines in their waiting rooms where you can self-check your blood pressure by sticking your arm in an electronic device.

If you don’t want to attend the doctors, pop into your pharmacy. Most high street pharmacies (e.g. Superdrug) have consultation rooms with nurses or pharmacists on hand to check your BP. There are also self-monitoring devices available to purchase so you can home monitor. Wrist devices are subject to more errors than hand held devices because patients may not position the device correctly in relation to the heart. Your high street pharmacist is best placed to advise you on monitors that meet the criteria for home testing.

The human heart
The human heart

How does having high blood pressure affect you day-to-day?

Generally it doesn’t which means that you can’t use the presence or absence of symptoms as a guide to your blood pressure reading.

Can you ever lower it or is HPB permanent?

You can correct blood pressure by taking medication, but management is usually lifelong i.e. you don’t simply get prescribed a course of tablets to tackle it as it is a regular rolling prescription tailored to your needs. Exercise, weight loss and lifestyle modification in terms of salt in the diet and stress etc. can also improve blood pressure. I have had numerous patients who have self-managed their blood pressure through reversing their bad habits.

Can it affect people of any age? How does it affect children?

It can affect anyone of any age however it is most common once you hit middle age and beyond. Half of all people over the age of 65 have high blood pressure. In terms of the adult population as a whole 1 in every 3 has high blood pressure and of those 1 in every 3 don’t know!

Does it go hand-in-hand with any other diseases?

It is seen more commonly in patients with kidney disease, endocrine disorders, pregnant women, and those who take certain medications or recreational drugs.

What do the numbers on a blood pressure monitor mean and how often should you take your own BP?

The top number i.e. the highest number is your systolic BP and is the measurement of pressure when the heart beats. The bottom is the lowest number and it the pressure measurement when the heart relaxes. All adults should have their blood pressure measured at least every 5 years once they hit 40. Free NHS Health check does this as part of the 5 yearly screen.

Can you control it without medication?

This is very much dependent on how severe your blood pressure is but weight loss, change of diet, exercise and stress reduction can have a big impact on getting your numbers down.