From the Guidelines
For a 76-year-old male with resistant hypertension, spironolactone should be started at a low dose of 25 mg once daily, as recommended by the most recent guidelines 1. This dose is appropriate considering the patient's age and potential sensitivity to medication effects. The dose can be adjusted based on blood pressure response and laboratory monitoring, with a maximum dose of 50 mg daily if needed and tolerated. Key considerations before starting spironolactone include checking baseline potassium and renal function, with follow-up testing within 1-2 weeks of initiation and after any dose adjustments 1. Spironolactone's mechanism as a potassium-sparing diuretic and aldosterone antagonist helps reduce sodium retention and blood pressure, but it should be used cautiously in patients with reduced kidney function, and concomitant use with potassium supplements or other potassium-sparing medications should be avoided due to the risk of hyperkalemia 1. Regular monitoring of blood pressure, electrolytes, and renal function is essential throughout treatment, and alternative treatments such as eplerenone, amiloride, or beta-blockers can be considered if spironolactone is not effective or tolerated 1. Some potential side effects to monitor for in elderly males include gynecomastia, and the importance of lifestyle modifications, such as sodium restriction, should also be emphasized 1. Overall, the management of resistant hypertension in this patient should prioritize careful monitoring, gradual dose adjustments, and consideration of alternative treatments as needed, with the goal of achieving optimal blood pressure control while minimizing risks and side effects.
From the FDA Drug Label
The recommended initial daily dose is 25 mg to 100 mg of spironolactone tablets administered in either single or divided doses is recommended. Dosage can be titrated at two-week intervals. Doses greater than 100 mg/day generally do not provide additional reductions in blood pressure. In patients with an eGFR between 30 and 50 mL/min/1. 73 m 2, consider initiating therapy at 25 mg every other day because of the risk of hyperkalemia
The initial dose of spironolactone for a 76-year-old male with resistant hypertension should be 25 mg to 100 mg daily. However, since the patient's eGFR is not provided, it is crucial to consider the risk of hyperkalemia and adjust the dose accordingly.
- If the patient's eGFR is between 30 and 50 mL/min/1.73 m^2, consider initiating therapy at 25 mg every other day.
- The dosage can be titrated at two-week intervals.
- Doses greater than 100 mg/day generally do not provide additional reductions in blood pressure 2.
From the Research
Spironolactone Dose for Resistant Hypertension
- The recommended dose of spironolactone for resistant hypertension is 25 to 50mg daily 3, 4, 5.
- This dose has been shown to be effective in reducing blood pressure in patients with resistant hypertension, with a mean reduction in systolic blood pressure of 16.6 to 26.0 mmHg and diastolic blood pressure of 7.0 to 10.7 mmHg 4.
- The addition of spironolactone to previous antihypertensive therapy has been shown to be effective in getting blood pressure to goal in most patients with resistant hypertension 6.
Considerations for Use in a 76-Year-Old Male
- The use of spironolactone in older adults requires careful monitoring of serum potassium levels, as the risk of hyperkalemia is increased in this population 4, 5.
- The dose of spironolactone may need to be adjusted based on the patient's renal function and other comorbidities 3, 7.
- The patient should be closely monitored for adverse effects, such as gynecomastia, which has been reported in 5.2% of male patients taking spironolactone 4.