| Title | Exploring the potential synergistic action of spironolactone on nitric oxide-enhancing therapy: insights from the African-American Heart Failure Trial. | | Author(s) | Ghali JK, Tam SW, Sabolinski ML, Taylor AL, Lindenfeld J, Cohn JN, Worcel M | | Institution | Wayne State University, Detroit, MI 48201, USA. jghali@med.wayne.edu | | Source | J Card Fail 2008 Nov; 14(9):718-23. | | MeSH | Adult
African Americans
Aged
Clinical Trials, Phase III as Topic
Drug Combinations
Drug Synergism
Female
Heart Failure
Humans
Hydralazine
Isosorbide Dinitrate
Male
Middle Aged
Multicenter Studies as Topic
Nitric Oxide Donors
Randomized Controlled Trials as Topic
Retrospective Studies
Spironolactone
| | Abstract | BACKGROUND: To investigate if treatment with an aldosterone antagonist affects the outcomes of treatment by fixed dose combination of isosorbide dinitrate/hydralazine (FDC I/H) or placebo in black heart failure (HF) patients treated with contemporary HF medications. In the African-American Heart Failure Trial (A-HeFT), FDC I/H was effective in reducing mortality and improving event-free survival. The beneficial effects of aldosterone antagonist (spironolactone [SP]), however have not been adequately assessed in black patients with or without the use of FDC I/H.
METHODS AND RESULTS: A retrospective analysis was performed in A-HeFT data base (n = 1050) to determine the effect of using SP (39% of patients) on outcomes. Baseline comparisons were done by 2-sample t-test or Fisher's exact test. Kaplan-Meier survival analyses were used for comparing between and within groups for outcomes. SP had no effect on mortality, event-free survival, or first HF hospitalization in the overall A-HeFT population. However, SP decreased mortality risk in the FDC I/H group by 59% (P = .03), and a favorable trend was noted on event-free survival and first HF hospitalization. In contrast, the use of SP was not associated with a decrease in mortality or HF hospitalizations in the placebo group.
CONCLUSIONS: This study suggests that in black patients with systolic heart failure on standard therapy of beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists, the beneficial effects of aldosterone antagonists require a background therapy of FDC I/H. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
| | PubMed ID | 18995175 |
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