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Association between long-term prescription of aldosterone antagonist and the progression of heart failure with preserved ejection fraction in hypertensive patients.
Int J Cardiol. 2016 Oct 01; 220:56-60.IJ

Abstract

BACKGROUND

Hypertension complicated with left ventricular hypertrophy (LVH) and diastolic dysfunction is independently related to increasing risk of subsequent incident heart failure with preserved ejection fraction (HFpEF). This study was designed to evaluate the influences of long-term aldosterone antagonist prescription in these patients.

METHODS

Using a propensity score matching of 1:2 ratio, this retrospective claims database study compared spironolactone prescription (n=65) and non-spironolactone therapy (n=130) in hypertensive patients with LVH [left ventricular mass index (LVMI)>125g/m(2) for men and >110g/m(2) for women] and suspected diastolic dysfunction (E/E' ratio between 8 and 15) and without clinical signs or symptoms of heart failure.

RESULTS

With a median follow-up of 7.4years, the new-onset symptomatic HFpEF occurred in 3 of 65 patients in the spironolactone group and 21 of 130 patients in the non-spironolactone group (P=0.021). Spironolactone also generated more prominent improvement in diastolic function and LVH. And multivariate logistic regression model revealed that spironolactone prescription (OR 0.177, 95% CI: 0.045-0.687, P=0.012) was associated with a reduced risk of new onset of symptomatic HFpEF, and the elevation of LVMI (OR 1.053, 95% CI: 1.011-1.097, P=0.012) or E/E' (OR 1.280, 95% CI: 1.015-1.615, P=0.037) was associated with a high risk of new onset of symptomatic HFpEF.

CONCLUSIONS

Long-term aldosterone antagonist exposure was associated with protective effects in terms of the incidence of new-onset symptomatic HFpEF, LV diastolic dysfunction and LVH in hypertensive patients, which might be beneficial for the delay of HFpEF progression.

Authors+Show Affiliations

Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. Electronic address: shxkliuxu@126.com.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27372043

Citation

Gu, Jun, et al. "Association Between Long-term Prescription of Aldosterone Antagonist and the Progression of Heart Failure With Preserved Ejection Fraction in Hypertensive Patients." International Journal of Cardiology, vol. 220, 2016, pp. 56-60.
Gu J, Fan YQ, Han ZH, et al. Association between long-term prescription of aldosterone antagonist and the progression of heart failure with preserved ejection fraction in hypertensive patients. Int J Cardiol. 2016;220:56-60.
Gu, J., Fan, Y. Q., Han, Z. H., Fan, L., Bian, L., Zhang, H. L., Xu, Z. J., Yin, Z. F., Xie, Y. S., Zhang, J. F., & Wang, C. Q. (2016). Association between long-term prescription of aldosterone antagonist and the progression of heart failure with preserved ejection fraction in hypertensive patients. International Journal of Cardiology, 220, 56-60. https://doi.org/10.1016/j.ijcard.2016.06.190
Gu J, et al. Association Between Long-term Prescription of Aldosterone Antagonist and the Progression of Heart Failure With Preserved Ejection Fraction in Hypertensive Patients. Int J Cardiol. 2016 Oct 1;220:56-60. PubMed PMID: 27372043.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between long-term prescription of aldosterone antagonist and the progression of heart failure with preserved ejection fraction in hypertensive patients. AU - Gu,Jun, AU - Fan,Yu-Qi, AU - Han,Zhi-Hua, AU - Fan,Li, AU - Bian,Ling, AU - Zhang,Hui-Li, AU - Xu,Zuo-Jun, AU - Yin,Zhao-Fang, AU - Xie,Yu-Shui, AU - Zhang,Jun-Feng, AU - Wang,Chang-Qian, Y1 - 2016/06/25/ PY - 2016/04/19/received PY - 2016/06/24/accepted PY - 2016/7/4/entrez PY - 2016/7/4/pubmed PY - 2017/8/30/medline KW - Aldosterone antagonist KW - Diastolic dysfunction KW - Heart failure with preserved ejection fraction KW - Hypertension KW - Left ventricular hypertrophy SP - 56 EP - 60 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 220 N2 - BACKGROUND: Hypertension complicated with left ventricular hypertrophy (LVH) and diastolic dysfunction is independently related to increasing risk of subsequent incident heart failure with preserved ejection fraction (HFpEF). This study was designed to evaluate the influences of long-term aldosterone antagonist prescription in these patients. METHODS: Using a propensity score matching of 1:2 ratio, this retrospective claims database study compared spironolactone prescription (n=65) and non-spironolactone therapy (n=130) in hypertensive patients with LVH [left ventricular mass index (LVMI)>125g/m(2) for men and >110g/m(2) for women] and suspected diastolic dysfunction (E/E' ratio between 8 and 15) and without clinical signs or symptoms of heart failure. RESULTS: With a median follow-up of 7.4years, the new-onset symptomatic HFpEF occurred in 3 of 65 patients in the spironolactone group and 21 of 130 patients in the non-spironolactone group (P=0.021). Spironolactone also generated more prominent improvement in diastolic function and LVH. And multivariate logistic regression model revealed that spironolactone prescription (OR 0.177, 95% CI: 0.045-0.687, P=0.012) was associated with a reduced risk of new onset of symptomatic HFpEF, and the elevation of LVMI (OR 1.053, 95% CI: 1.011-1.097, P=0.012) or E/E' (OR 1.280, 95% CI: 1.015-1.615, P=0.037) was associated with a high risk of new onset of symptomatic HFpEF. CONCLUSIONS: Long-term aldosterone antagonist exposure was associated with protective effects in terms of the incidence of new-onset symptomatic HFpEF, LV diastolic dysfunction and LVH in hypertensive patients, which might be beneficial for the delay of HFpEF progression. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/27372043/Association_between_long_term_prescription_of_aldosterone_antagonist_and_the_progression_of_heart_failure_with_preserved_ejection_fraction_in_hypertensive_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(16)31161-5 DB - PRIME DP - Unbound Medicine ER -