Key result
Spironolactone 50 mg improves 6-minute walk distance by ~25 meters vs 25 mg in HFrEF.
Why the study?
Effective treatment of systolic heart failure is crucial to reduce disability and recurrent hospitalizations, motivating a direct comparison of spironolactone at doses of 25 mg and 50 mg.
Does spironolactone 50 mg daily improve performance capacity, quality of life, and ejection fraction compared to 25 mg daily in patients with systolic heart failure?
RCT (n=100)
Triple-blind
Simple randomization
No
Does spironolactone 50 mg daily improve performance capacity, quality of life, and ejection fraction compared to 25 mg daily in patients with systolic heart failure?
Absolute Event Rate: 204.3% vs 178.9%
p-value: p=<0.001
In patients with systolic heart failure, a 50 mg daily dose of spironolactone significantly improved quality of life and exercise capacity compared to a 25 mg dose, without causing hyperkalemia.
50 mg spironolactone improves QoL and functional capacity versus 25 mg in systolic HF; extends dose-finding data but needs outcome trials before practice change.
Background & Objective: Heart failure (HF), as the final stage of cardiovascular disease, is a prevalent cause of mortality, disability, and recurrent hospitalization.Effective treatment of systolic HF is crucial for reducing patient disability and preventing repeated hospital admissions.In this context, we aimed to conduct a comparative study of spironolactone at doses of 25 mg and 50 mg in patients with systolic HF.Materials & Methods: This randomized clinical trial was performed on 100 patients with systolic HF.The patients were randomly divided into two treatment groups receiving 25 and 50 mg of spironolactone.Subsequently, changes in ejection fraction, frequency of hospitalization, performance capacity, quality of life, and electrolyte disorders were examined.Results: There was no significant difference between the groups in terms of age, sex, cardiovascular risk factors, history of cerebrovascular accidents, readmission rate, and EF changes (P>0.05).At the end of the study, the mean scores of performance capacity and quality of life in patients receiving 50 mg of spironolactone were 204.328 and 323.1, respectively.These values were statistically higher than those reported in patients receiving 25 mg of spironolactone (178.930 and 36.73.3,respectively) (P<0.001).In patients who received 50 mg of spironolactone, the average levels of potassium and blood urea nitrogen were 0.680.08 and 6.11.4,respectively.These levels were significantly higher compared to those in patients receiving a 25mg dose, where the levels were 0.390.17and 4.72.8,respectively (P<0.05).However, it is important to note that the maximum values observed did not exceed the normal range for these parameters Conclusion: Compared to the 25mg dose, the 50mg dose of spironolactone was observed to enhance both the quality of life and performance capacity in patients with systolic HF.Therefore, it can be prescribed as the initial daily dosage for managing patients with HF.
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Assareh et al. (2024) conducted an RCT in Systolic heart failure (n=100). Spironolactone vs. 25 mg daily was evaluated on Performance capacity (6-Minute Walk Test distance in meters) (p=<0.001). Spironolactone at a daily dose of 50 mg significantly improved 6-Minute Walk Test distance (204.3 vs 178.9 meters, p<0.001) compared to a 25 mg dose in patients with systolic heart failure.
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