Spironolactone and hydrochlorothiazide decrease vascular stiffness and blood pressure in geriatric hypertension.
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.