Spironolactone 25 mg daily reduced BNP (-53.4 vs +3.3 pg/mL; P=0.04) and collagen turnover but impaired renal function and quality of life in patients with mild-moderate heart failure.
RCT (n=40)
double-blind
parallel-group
Does spironolactone 25 mg daily improve neurohumoral activation and collagen turnover in patients with mild-moderate heart failure taking an ACE inhibitor and beta-blocker?
In patients with mild-moderate HFrEF on ACE inhibitors and beta-blockers, spironolactone reduces neurohumoral activation and collagen turnover but may impair renal function and quality of life.
Absolute Event Rate: -53.4% vs 3.3%
p-value: p=0.04
Abstract Aims Spironolactone improves prognosis in severe heart failure (HF). We investigated its effects in patients with mild–moderate HF treated with an ACE inhibitor and beta-blocker. Methods and results Randomised, double-blind, parallel-group, 3-month comparison of placebo and spironolactone (25 mg daily) in 40 patients in New York Heart Association (NYHA) class I (20%), II (70%) or III (10%), with a left ventricular ejection fraction of 40%. The mean (standard error) changes from baseline in the spironolactone and placebo groups were, respectively: i) B-type natriuretic peptide (BNP) −53.4(22.2) pg/mL and +3.3(12.1) pg/mL, P=0.04, ii) pro-collagen type III N-terminal amino peptide (PIIINP) −0.6(0.2) μmol/L and +0.02(0.2) μmol/L, P=0.02 and iii) creatinine +10.7(3.2) μmol/L and −0.3(2.6) μmol/L, P=0.01. Compared with placebo, spironolactone therapy was associated with a reduction in self-reported health-related quality of life: change in visual analog score: −6 (3) vs. +6 (4); P=0.01. No differences were observed on other biochemical, neurohumoral, exercise and autonomic function assessments. Conclusion In patients with mild–moderate HF, spironolactone reduced neurohumoral activation (BNP) and a marker of collagen turnover (PIIINP) but impaired renal function and quality of life. The benefit–risk ratio of aldosterone blockade in mild HF is uncertain and requires clarification in a large randomised trial.
Berry et al. (Tue,) conducted a rct in mild-moderate heart failure (n=40). spironolactone vs. placebo was evaluated on Change from baseline in B-type natriuretic peptide (BNP) (pg/mL) (p=0.04). Spironolactone 25 mg daily reduced BNP (-53.4 vs +3.3 pg/mL; P=0.04) and collagen turnover but impaired renal function and quality of life in patients with mild-moderate heart failure.
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