A systematic review and meta-analysis of effects of spironolactone on blood pressure, glucose, lipids, renal function, fibrosis and inflammation in patients with hypertension and diabetes

Figures & data

Figure 1. Flow diagram of study selection.

Table 1. Characteristics of studies including in the meta-analysis.

Study	Cross-over design	Dose (mg/day)	Duration	Sample size^&	Mean age (years)	No. of male/female
Davies et al.[20]	Yes	50	1 month	42/42	60	13/29
Davies et al.[21]	Yes	25–50	4 months	10/10	66	7/3
Rossing et al.[22]	Yes	25	8 weeks	20/20	58	17/3
Schjoedt et al.[23]	Yes	25	2 months	20/20	45	15/5
van den Meiracker et al.[24]	No	25–50	1 year	24/28	51.5	33/19
Saklayen et al.[16]	Yes	25–50	3 months	24/24	64.5	Male
Swaminathan et al.[15]	Yes	25–50	4 weeks	38/38	62.6	28/10
Kosmala et al.[25]	No	25	6 months	40/39	59	36/43
Nielsen et al.[26]	Yes	25	60 days	21/21	58.3	14/7
Oxlund et al.[14]	No	25–50	16 weeks	61/58	63.4*	91/28
Kanchan et al.[27]	No	25	12 weeks	20/20	43.2*	37/3

*Mean age calculated from mean age of subgroup, weighted by sample size. ^&Sample sizes showed as spironolactone/placebo group.

Table 2. Baseline information of included studies.

Study	Baseline SBP (mmHg)^&	Baseline DBP (mmHg)^&	ACEi/ARBs^#	DM type	Baseline FBG	Baseline HbA1c	Baseline K^+
Davies et al.[20]	145 ± 18.7	78 ± 10.1	20 (47.6%)	Type 2	NA	7.79 ± 1.24	4.19 ± 0.28
Davies et al.[21]	145 ± 15	78 ± 9	2 (20%)	Type 2	NA	7.57 ± 1.24	NA
Rossing et al.[22]	NA	NA	20 (100%)	Type 2	NA	NA	NA
Schjoedt et al.[23]	NA	NA	20 (100%)	Type 1	NA	NA	NA
van den Meiracker et al.[24]	144 ± 17 vs. 148 ± 13	80 ± 10 vs. 82 ± 8	24 (100%)	Type 2	NA	8.2 ± 1.5	4.2 ± 0.3
Saklayen et al.[16]	153.6 ± 25.9 vs. 154.52 ± 21.2	79.6 ± 12.2 vs. 79.7 ± 12.9	24 (100%)	Type 2	NA	NA	4.29 ± 0.47
Swaminathan et al.[15]	162.7 ± 17.2	88.9 ± 9.2	38 (100%)	Type 2	NA	7.03 ± 1.5	4.3 ± 0.3
Kosmala et al.[25]	143 ± 16 vs. 139 ± 12	82 ± 9 vs. 82 ± 6	40 (100%)	Unclear	123 ± 33	NA	4.2 ± 0.3
Nielsen et al.[26]	NA	NA	21 (100%)	Type 1	NA	NA	NA
Oxlund et al.[14]	144 ± 15 vs. 139 ± 15	79 ± 11 vs. 76 ± 8	61 (100%)	Type 2	NA	7.45*	3.85*
Kanchan et al.[27]	124.3 ± 6.1 vs. 127.8 ± 4.5	83.6 ± 3.3 vs. 84.6 ± 2.8	20 (100%)	Unclear	140.5 ± 32.4	NA	3.72 ± 0.27

*Calculated from mean of subgroup, weighted by sample size. ^& BPs showed as spironolactone/placebo group. ^#Number (percentage) in spironolactone group. SBP: systolic blood pressure; DBP: diastolic blood pressure; ACEi: angiotensin-converting enzyme inhibitors; ARBs: angiotensin receptor blockers; DM: diabetes mellitus; FBG: fasting blood glucose; HbA1c: glycosylated haemoglobin. NA: not applicable.

Figure 2. Effect of spironolactone on blood pressure.

Table 3. Meta-analysis for effect of spironolactone on glucose, lipids, renal function.

Analysis	No. of studies	Mean difference	p Value	Heterogeneity
		(95% CI)		I^2	p Value
Glycometabolism
FBG	3	0.11 (–0.21, 0.43)	0.51	0	0.64
HbA1c	5	0.30 (0.22, 0.37)	<0.001	26	0.24
Lipid metabolism
Total cholesterol	4	0.02 (–0.07, 0.11)	0.63	29	0.24
LDL-C	3	–0.01 (–0.17, 0.16)	0.94	75	0.02
HDL-C	4	0.00 (–0.03, 0.03)	0.98	42	0.16
Renal function
Serum creatinine	5	7.60 (4.94, 10.27)	<0.001	0	0.53
eGFR	4	–4.28 (–6.38, −2.18)	<0.001	0	0.67

FBG: fasting blood glucose; HbA1c: glycosylated haemoglobin; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; eGFR: estimated glomerular filtration rate. CI: confidence interval.

Figure 3. Effect of spironolactone on potassium.

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Oxlund CS, Henriksen JE, Tarnow L, et al. Low dose spironolactone reduces blood pressure in patients with resistant hypertension and type 2 diabetes mellitus: a double blind randomized clinical trial. J Hypertens. 2013;31(10):2094–2102.

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