Key result
In patients with a hypertensive response to exercise, 3 months of spironolactone reduced blood pressure and LVMI but did not significantly alter peak systolic strain (0.3% vs -0.1%, P=0.56).
Why the study?
Does spironolactone improve vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise?
RCT (n=115)
Double-blind
Randomized
Does spironolactone improve vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise?
Absolute Event Rate: 0.3% vs -0.1%
p-value: p=0.56
Short-term spironolactone in patients with a hypertensive response to exercise reduces blood pressure and LV mass index but does not significantly improve exercise capacity or myocardial strain.
Spironolactone reduces BP and LVMI without improving strain in exercise hypertension; confirms mass effects but challenges functional benefits.
BACKGROUND: Although a hypertensive response to exercise (HRE) is associated with cardiac risk and masked hypertension (MHT), its mechanisms and appropriate treatment remain unclear. We investigated spironolactone as a treatment for abnormal vascular and myocardial stiffness in HRE. METHODS: In this randomized, double-blind, placebo-controlled study of 115 patients (54 ± 9 years, 57% men) with an HRE (≥210/105 mm Hg in men; ≥190/105 mm Hg in women) but no prior history of hypertension or myocardial ischemia, MHT prevalence was 40%. Patients were randomized to spironolactone 25mg daily (n = 58) or placebo (n = 57) and underwent evaluation at baseline and 3 months with exercise echocardiography, VO2max, pulse wave velocity (PWV), exercise and central blood pressure (BP), and 24-hour ambulatory BP. Changes in left ventricular mass index (LVMI), Doppler-derived E/em ratio (LV filling pressure), and myocardial strain were assessed. RESULTS: Baseline 24-hour systolic BP (SBP) was 133 ± 10 mm Hg and peak-exercise SBP was 219 ± 16 mm Hg. Peak systolic strain (0.3 ± 3.6% vs. -0.1 ± 3.2, P = 0.56), E/em (-1.1 ± 2.3 vs. -0.6 ± 1.7, P = 0.30), VO(2max) (0.4 ± 4.9 vs. -0.9 ± 4.1 ml/kg/min, P = 0.15), and adjusted PWV did not significantly change with treatment, despite reduction in exercise SBP, 24-hour SBP, and LVMI. The change in exercise E/em was of borderline significance (-0.3 ± 2.4 vs. 0.8 ± 2.8, P = 0.06) and became significant after adjustment for baseline differences (P = 0.01). Patients with higher LVMI significantly increased VO(2max) (1.1 ± 5.6 vs. -2.4 ± 4.4 ml/kg/min, P < 0.05) and reduced exercise E/e(m) (-0.7 ± 2.7 vs. 1.9 ± 2.8, P < 0.05). CONCLUSIONS: In HRE patients without previous hypertension, short-term spironolactone reduced exercise BP, 24-hour ambulatory BP, LVMI, and E/e(m) but did not significantly alter exercise capacity or myocardial strain.
No takes yet. Share an insight, caveat, or question.
Hare et al. (2013) conducted an RCT in Hypertensive response to exercise (HRE) (n=115). Spironolactone vs. Placebo was evaluated on Change in peak systolic strain (p=0.56). In patients with a hypertensive response to exercise, 3 months of spironolactone reduced blood pressure and LVMI but did not significantly alter peak systolic strain (0.3% vs -0.1%, P=0.56).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: