Spironolactone treatment for dermatologic conditions and blood pressure changes in hypertensive patients on concomitant antihypertensive therapy

Summary: Abstract Body: Spironolactone, prescribed off-label for acne, androgenetic alopecia, and hirsutism, is not associated with significant blood pressure (BP) changes. However, its effect when combined with antihypertensives remains understudied. Using the TriNetX Research Network, we retrospectively analyzed 753 hypertensive patients concurrently treated with spironolactone for dermatologic conditions (2004–2024). BP before and after spironolactone initiation was compared using a two-sample T-test. Mean systolic and diastolic BPs decreased overall (134- to 130-mmHg, 82- to 79-mmHg; P<0.001) and for beta-blockers, angiotensin-receptor-blockers, and thiazides. Hypotension diagnoses increased by 1.5%, but absolute hypotension was rare. Subgroup analysis showed BP decreases in White and Black patients. Limitations included retrospective design, unverified adherence, and absence of dose-response analysis. Spironolactone appears safe for most patients on antihypertensives, but individuals with low baseline BP or multiple BP medications may face higher hypotension risk. Therefore, we recommend collaborating with primary care physicians and monitoring baseline and interval BP measurements in this patient population. Ryan Chan¹, Zachary Neubauer², Michael Ong³, Karen A. Chernoff³, Shari Lipner³ 1. New York Medical College, Valhalla, NY, United States. 2. Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, United States. 3. Weill Cornell Medicine, New York, NY, United States. Clinical Research: Epidemiology and Observational Research