Spironolactone reduced SBP by 4.4 ± 0.6 mmHg compared with placebo, but this blood pressure lowering did not account for its potential cardiovascular benefits in patients with HFpEF.
RCT (n=1,645)
Yes
Does baseline systolic blood pressure or spironolactone-induced blood pressure lowering affect cardiovascular outcomes in patients with HFpEF?
In patients with HFpEF, baseline SBP is not associated with cardiovascular outcomes, and the benefits of spironolactone are not mediated by its blood pressure-lowering effects.
AIMS: Recent guidelines have advocated for stricter systolic blood pressure (SBP) control in heart failure with preserved ejection fraction (HFpEF), though data regarding the optimal SBP in HFpEF are sparse. METHODS AND RESULTS: We analysed participants from the Americas from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study with available baseline and 8-week visit SBP data (n = 1645). We related baseline SBP to several efficacy and safety outcomes. To determine whether blood pressure lowering was responsible for the potential beneficial effects of spironolactone observed in the Americas, we assessed the randomized treatment adjusting for baseline and change in 8-week SBP. The average age was 71.7 ± 9.7 years, 50% were women, and 79% were White. Patients in the lowest baseline SBP quartile were less often female, more often White, had lower body mass index, lower baseline diastolic blood pressure and pulse pressure, and more often had atrial fibrillation. After multivariable adjustment, there was no relationship observed between baseline SBP quartiles and any outcome. Spironolactone reduced SBP by 4.4 ± 0.6 mmHg compared with placebo (and consistently across baseline SBP quartiles). There was minimal change in the treatment effect for all outcomes after adjusting for baseline SBP and 8-week change in SBP. CONCLUSION: No relationship was observed between baseline SBP quartiles and outcomes in TOPCAT. The anti-hypertensive effects of spironolactone did not account for the potential benefit in cardiovascular outcomes in the Americas.
Selvaraj et al. (Thu,) conducted a rct in Heart failure with preserved ejection fraction (HFpEF) (n=1,645). Spironolactone vs. Placebo was evaluated on Efficacy and safety outcomes. Spironolactone reduced SBP by 4.4 ± 0.6 mmHg compared with placebo, but this blood pressure lowering did not account for its potential cardiovascular benefits in patients with HFpEF.