J Hypertens. 2006;24:2285-2292


Adding spironolactone to an ACE inhibitor or angiotensin II receptor blocker (ARB) is associated with a marked and sustained antiproteinuric effect in type 2 diabetics, researchers in the Netherlands found.

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Anton H. van den Meiracker, MD, of the ErasmusMedicalCenter in Rotterdam, and his group studied 59 patients with type 2 diabetes with macroalbuminuria that persisted despite long-term use of an ACE inhibitor or ARB. Twenty-nine patients were assigned to receive spironolactone 25-50 mg once daily in addition to their ACE inhibitor or ARB and 30 were assigned to receive placebo.


Hyperkalemia developed in five patients in the spiro- nolactone group and one in the placebo group, and these patients had to be excluded. Albuminuria decreased by 40.6% and BP by 7 mm Hg in the spironolactone group but did not change in the placebo group.


During one year of follow-up, estimated glomerular filtration rate declined on average by 12.9 mL/min per 1.73 m2 in the spironolactone group and 4.9 mL/min per 1.73 m2 in the placebo group.