© 2007 European Society of Cardiology
Effects of aldosterone receptor blockade in patients with mild–moderate heart failure taking a beta-blocker
a Department of Cardiology, Western Infirmary Glasgow, UK
b Department of Applied Physiology, University of Strathclyde Glasgow, UK
c Institute for Sports Research, University of Stirling Stirling, UK
d Department of Metabolic Medicine, Queen Elizabeth Building, Royal Infirmary Glasgow, UK
e Department of Clinical Pharmacology, University College Hospital London, UK
* Corresponding author. Department of Cardiology, Western Infirmary, Glasgow, G11 6NT, UK. Tel.: +44 141 3303479; fax: +44 141 3306955. E-mail address: j.mcmurray{at}bio.gla.ac.uk
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Abstract |
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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.
Key Words: Aldosterone • Spironolactone • Heart failure
Received May 30, 2006; Revised August 21, 2006; Accepted October 5, 2006
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