Abstract

Introduction: Aldosterone has been implicated in the pathophysiology of both metabolic syndrome (MS) and MS-associated arterial hypertension, despite the use of mineralocorticoid receptor antagonists in these scenarios has been little studied. Objectives: To assess the effects of mineralocorticoid blockade on blood pressure as well as metabolic and renal parameters in mild hypertensive subjects with MS compared with an active control group. Methods: 27 individuals with the MS were assessed in a quasi-experimental real life study in which the experimental group (SPIRO) received spironolactone (25 to 50 mg/day) and the control group (AMLO) were in use of amlodipine, at dose of 5-10 mg/day, with the aim to reach a blood pressure target of 130/80 mmHg. After a treatment period that lasted 16 weeks, all clinical and laboratorial parameters were reassessed as well as 24 hour ambulatory blood pressure monitoring (24 h-ABPM) and flow-mediated dilation (FMD). Results: Sixteen subjects were included in spironolactone group and 11 in amlodipine group (active control). At the end of 16 weeks of treatment there was a significant decrease in both, 24-hour systolic -23.98 mmHg, CI: -34.85 to -13.11, in spironolactone group, and -14.36 mmHg, CI: -25.83 to 2.89, in amlodipine group and diastolic pressure -12.84 mmHg, CI: -9.82 to -5.87, in the spironolactone group and -9.59 mmHg, CI: -16.97 to -2.21, in amlodipine group. No significant changes have been noted in the metabolic profile, as assessed by Homeostasis Model Assessment (HOMA-IR), triglycerides and potassium in both groups. In spironolactone group we detected a significant reduction in albuminuria levels, with no significant changes seen in amlodipine group. In addition, we found a significant reduction in C-reactive protein in spironolactone group and a significant increase in C-reactive protein in amlodipine group. We also found a significant association between the decrease in high-sensitivity C-Reactive Protein and flow-mediated dilation improvement in patients treated with spironolactone. Conclusion: Spironolactone as monotherapyin hypertensive subjects presenting metabolic syndrome was effective in blood pressure control, had additional benefits on endothelial function, observed from C-reactive protein reduction and flow mediated dilation as well as had a potential renal protective effect through decrease in albuminuria excretion.

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