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