Spironolactone vs Amiloride for Resistant Hypertension: A Randomized Clinical Trial
Authors' conclusion
Amiloride was noninferior to spironolactone in lowering home SBP
Study context
- Population
- Resistant hypertension: home systolic blood pressure (SBP) ≥130 mm Hg after 4-week run-in on fixed-dose ARB, calcium channel blocker and thiazide
- Participants
- 118 participants
- Comparison
- Amiloride vs spironolactone
- Amiloriden = 58
- Spironolactonen = 60reference
- Primary endpoint
- Between-group difference in home SBP change (non-inferiority margin −4.4 mm Hg for lower CI bound)
- Follow-up
- Week 12
Methodological detailsopen-label, blinded end-point, non-inferiority, 14 sites in South Korea
- Open-label
- Blinded end-point
- Non-inferiority
- 14 sites in South Korea
Primary result
Home SBP change from baseline
Between-group difference in change
−0.68 mm Hg
90% CI −3.50 to 2.14
Change by group
Amiloride
−13.6
mean change · SD 8.6 · mm Hg
Spironolactone
−14.7
mean change · SD 11.0 · mm Hg
Amiloride vs Spironolactone
between-group difference in change −0.68 mm Hg (90% CI −3.50 to 2.14)
As reported in the abstract
Secondary outcomes
Achievement of home SBP <130 mm Hg
Achievement of office SBP <130 mm Hg
Achievement of home SBP <130 mm Hg
- No difference between the 2 groups
Achievement of office SBP <130 mm Hg
- No difference between the 2 groups
Safety
Events
| Outcome | Spironolactone | Amiloride | |
|---|---|---|---|
| Hyperkalemia-related discontinuation | Not reported in the abstract | 1 | Spironolactone: not reported in the abstract |
| Gynecomastia | 0 | 0 |
Original publication
Spironolactone vs Amiloride for Resistant Hypertension: A Randomized Clinical Trial. JAMA. Published 17 June 2025. doi:10.
Summarised from the published abstract; every number is checked against it