Over the last few posts, we have reviewed spironolactone and eplerenone as precision medicine. These are medications that interfere with the biology that causes hypertension, diabetes, heart attack, heart failure, and chronic kidney disease. They are especially effective in resistant hypertension—high blood pressure that is not controlled on three medications.
“Consistent with reports of a high prevalence of primary aldosteronism in patients with resistant hypertension have been studies demonstrating that mineralocorticoid receptor antagonists provide significant antihypertensive benefit when added to existing multidrug regimens. In an evaluation of 76 patients referred to a university hypertension clinic for poorly controlled hypertension, spironolactone (12.5 to 50 mg daily) in an open-label evaluation lowered blood pressure on average by an additional 25 mm Hg systolic and 12 mm Hg diastolic.”
These drugs are mineralocorticoid receptor (MR) antagonists. They interfere with the fundamental mechanisms that cause high blood pressure, high sugar and complications. Only 44% of Americans with hypertension have their blood pressure controlled. Spironolactone and eplerenone should be among the most frequently used medications in our country, but they are dramatically underused. The other medications in our hypertension protocol are in the top eleven most prescribed medications in the country. Spironolactone is fifty-first. Eplerenone does not even make the list of the 200 most commonly prescribed drugs. When spironolactone was first introduced, it was used in very high doses-sometimes as much as 200 mg a day. Of course, kidney problems and high potassium were much more common and that may impact use now. As small a dose as 12.5 mg of spironolactone blocks some of the signaling that causes disease. It can lower the blood pressure significantly. If you watch the potassium and kidney function carefully at initiation and dosage change. Start with a low dose and stop at 25 mg. That is very safe in most people. It is even safer if started earlier.
Interesting. I will keep this in mind. For the second time now I’ve been in a medical emergency and the docs want to fill me with new stronger BP meds and continue to do so. My anxiety is off the chart at those times. Yes. Control it at the moment but I want some efforts to help me back off them later. I just got home yesterday from a broken femur head surgery snd now I’m on 2 BP meds? I’m just venting here doctor. I have a functional medicine doc too so will consult with her.