• aldosterone;
  • pulse wave velocity;
  • vascular stiffness;
  • ambulatory blood pressure monitoring

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.