Cardiology Letters 2021, 30(2):104-110

Spironolactone and its use in the treatment of arterial hypertension in real world practice in the Slovak Republic

Szalay T¹, Tulejová H², Mužik R³, Halušťoková K², Hatala R⁴

¹ Stredoeurópsky inštitút pre zdravotnú politiku - Health Policy Institute, Bratislava

² Advance Healthcare Management Consulting, s. r. o., Bratislava

³ Dôvery, zdravotná poisťovňa, a. s.

⁴ Národný ústav srdcových a cievnych chorôb, a. s. a Lekárská fakulta Slovenskej zdravotníckej univerzity, Bratislava, Slovenská republika

Spironolactone is a mineralocorticoid receptor antagonist that has been used in internal medicine for over 60 years, especially in the treatment of fluid retention. Based on evidence-based medicine, an explicit indication for the administration of spironolactone for the treatment of resistant hypertension not sufficiently responsive to the triple combination of antihypertensives (optimal: renin angiotensin system blocker + calcium channel blocker + diuretic) was included in the European ESH/ESC Guidelines for the Management of Arterial Hypertension for the first time in 2018. The aim of the work was a retrospective analysis of the use of spironolactone in the treatment of primary arterial hypertension in outpatient practice in Slovakia. Data set and methods: The subject of the analysis was the prescription of antihypertensives in 155.359 patients treated for hypertension during the 12-month reference period (10/2017-9/2018). Administrative data from the health insurance company were used to classify hypertension and comorbidities affecting the pharmacotherapy of hypertension. We also analyzed the data with a focus on subgroups: 1. uncomplicated hypertension - hypertension without comorbidities, 2. hypertension in combination with coronary heart disease, 3. hypertension in combination with diabetes mellitus and 4. hypertension in combination with heart failure.

Results: The overall prescription of spironolactone was very low during the reference period - the drug was prescribed to 2 010 patients (1.3%). In most patients (n = 1 097; 54.6%), spironolactone was prescribed, earlier than after 3 drugs. Patients in combination with heart failure had spironolactone prescribed 3.5 times more often than other patients with hypertension.

Conclusions: Despite its potential, spironolactone was rarely used in Slovakia during the reference period in the treatment of hypertension. When used, it was mostly in drug combinations that do not comply with the latest guidelines. The implementation of recommendations for the use of aldosterone antagonists in the treatment of primary hypertension in real world practice in the Slovak Republic will require targeted education of all physicians involved in the management of hypertensive patients.

Keywords: hypertension; spironolactone; eplerenone; mineralocorticoid receptor antagonist; ESH, ESC guidelines 2013; ESH, ESC guidelines 2018

Published: February 1, 2021  Show citation