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Spironolactone improved outcomes in hypertensive patients with diastolic HF
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MUNICH — Mineralocorticoid receptor blockade with spironolactone improved cardiac function and structure, reduced neuroendocrine activation and effectively reduced BP in patients with symptomatic hypertensive diastolic HF enrolled in the Aldo-DHF trial.
These results led researcher Burkert Pieske, MD, head of cardiology at the Medical University Graz, Austria, to conclude that mineralocorticoid receptor anagonists should be considered as a treatment option for this patient population.
Pieske presented data from the randomized, placebo-controlled, double blind, parallel-group, international, phase 2b Aldo-DHF trial during a Hot Line session and press conference at the European Society of Cardiology Congress 2012.
The trial was designed to test the hypothesis that 1 year of treatment with spironolactone would improve cardiac function and structure, exercise capacity and quality of life in this patient population, Pieske said at the press conference. Researchers randomly assigned 422 patients with symptomatic diastolic HF to spironolactone to a target dose of 25 mg per day or placebo for 1 year. The two co-primary endpoints were changes in diastolic function (filling pressure, assessed noninvasively by tissue-Doppler derived E/é) and changes in maximal exercise capacity (peak VO2) determined by bicycle spiroergometry after 1 year, according to a press release.
Patients assigned spironolactone experienced significant improvements in diastolic function, as assessed by a significant decline in E/é. The drug also induced reverse cardiac modeling and reduced left ventricular hypertrophy, NT-proBNP levels, and systolic and diastolic BP.
However, there was no change in peak VO2 or HF symptoms, including NYHA Class and quality of life, after 1 year.
The drug was shown to be safe and was not associated with relevant adverse outcomes, Pieske said at the conference. – by Katie Kalvaitis
For more information:
Pieske B. Hot line I: Late breaking trials on prevention to heart failure. Presented at: the European Society of Cardiology Congress; Aug. 25-29, 2012; Munich.
Disclosure: Dr. Pieske reports no relevant financial disclosures.