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Effect of Spironolactone on Exercise Tolerance and Arterial Function in Older Adults with Heart Failure with Preserved Ejection Fraction.
J Am Geriatr Soc. 2017 Nov; 65(11):2374-2382.JA

Abstract

OBJECTIVES

To evaluate the effects of an aldosterone antagonist on exercise intolerance in older adults with heart failure and preserved ejection fraction (HFpEF).

DESIGN

Randomized, placebo-controlled, double-blind trial.

SETTING

Academic medical center, Winston-Salem, North Carolina.

PARTICIPANTS

Older adults (N = 80, aged 71 ± 1; 80% female) with stable compensated HFpEF and controlled blood pressure (BP).

MEASUREMENTS

Participants were randomized into a 9-month treatment of spironolactone 25 mg/d vs placebo. Assessments were peak exercise oxygen consumption (VO2), 6-minute walk test, Minnesota Living with Heart Failure Questionnaire (MLHFQ), cardiac magnetic resonance imaging, Doppler echocardiography, and vascular ultrasound.

RESULTS

Seventy-one participants completed the trial: 37 in the spironolactone group and 34 in the placebo group. Adherence according to pill count was excellent (spironolactone 95%, placebo 97%). Mean spironolactone dose was 24.3 ± 2.9 mg/d and was well tolerated. Spironolactone significantly reduced systolic and diastolic BP at rest and peak exercise. At 9-month follow-up, baseline-adjusted peak VO2, the primary outcome, was 13.5 ± 0.3 mL/kg per minute in the spironolactone group versus 13.9 ± 0.3 mL/kg per minute in the placebo group (adjusted mean difference -0.4 mL/kg per minute; 95% confidence interval = -1.1-0.4 mL/kg per minute; P = .38). The 95% confidence intervals of spironolactone's effect on peak VO2 (-8.2% to 3.2%) excluded a clinically significant beneficial effect. There were also no significant differences in 6-minute walk distance, arterial stiffness, left ventricular (LV) mass, LV mass/end-diastolic volume, or MLHFQ score.

CONCLUSION

In older adults with stable compensated HFpEF, 9 months of spironolactone 25 mg/d was well tolerated and reduced BP but did not improve exercise capacity, quality of life, LV mass, or arterial stiffness.

Authors+Show Affiliations

Cardiovascular Medicine Section, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.Cardiovascular Medicine Section, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.Cardiovascular Medicine Section, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.Cardiovascular Medicine Section, Department of Internal Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28542926

Citation

Upadhya, Bharathi, et al. "Effect of Spironolactone On Exercise Tolerance and Arterial Function in Older Adults With Heart Failure With Preserved Ejection Fraction." Journal of the American Geriatrics Society, vol. 65, no. 11, 2017, pp. 2374-2382.
Upadhya B, Hundley WG, Brubaker PH, et al. Effect of Spironolactone on Exercise Tolerance and Arterial Function in Older Adults with Heart Failure with Preserved Ejection Fraction. J Am Geriatr Soc. 2017;65(11):2374-2382.
Upadhya, B., Hundley, W. G., Brubaker, P. H., Morgan, T. M., Stewart, K. P., & Kitzman, D. W. (2017). Effect of Spironolactone on Exercise Tolerance and Arterial Function in Older Adults with Heart Failure with Preserved Ejection Fraction. Journal of the American Geriatrics Society, 65(11), 2374-2382. https://doi.org/10.1111/jgs.14940
Upadhya B, et al. Effect of Spironolactone On Exercise Tolerance and Arterial Function in Older Adults With Heart Failure With Preserved Ejection Fraction. J Am Geriatr Soc. 2017;65(11):2374-2382. PubMed PMID: 28542926.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Spironolactone on Exercise Tolerance and Arterial Function in Older Adults with Heart Failure with Preserved Ejection Fraction. AU - Upadhya,Bharathi, AU - Hundley,William G, AU - Brubaker,Peter H, AU - Morgan,Timothy M, AU - Stewart,Kathryn P, AU - Kitzman,Dalane W, Y1 - 2017/05/19/ PY - 2017/5/26/pubmed PY - 2017/11/29/medline PY - 2017/5/26/entrez KW - aging KW - aldosterone antagonist KW - arterial function KW - exercise tolerance KW - heart failure SP - 2374 EP - 2382 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 65 IS - 11 N2 - OBJECTIVES: To evaluate the effects of an aldosterone antagonist on exercise intolerance in older adults with heart failure and preserved ejection fraction (HFpEF). DESIGN: Randomized, placebo-controlled, double-blind trial. SETTING: Academic medical center, Winston-Salem, North Carolina. PARTICIPANTS: Older adults (N = 80, aged 71 ± 1; 80% female) with stable compensated HFpEF and controlled blood pressure (BP). MEASUREMENTS: Participants were randomized into a 9-month treatment of spironolactone 25 mg/d vs placebo. Assessments were peak exercise oxygen consumption (VO2), 6-minute walk test, Minnesota Living with Heart Failure Questionnaire (MLHFQ), cardiac magnetic resonance imaging, Doppler echocardiography, and vascular ultrasound. RESULTS: Seventy-one participants completed the trial: 37 in the spironolactone group and 34 in the placebo group. Adherence according to pill count was excellent (spironolactone 95%, placebo 97%). Mean spironolactone dose was 24.3 ± 2.9 mg/d and was well tolerated. Spironolactone significantly reduced systolic and diastolic BP at rest and peak exercise. At 9-month follow-up, baseline-adjusted peak VO2, the primary outcome, was 13.5 ± 0.3 mL/kg per minute in the spironolactone group versus 13.9 ± 0.3 mL/kg per minute in the placebo group (adjusted mean difference -0.4 mL/kg per minute; 95% confidence interval = -1.1-0.4 mL/kg per minute; P = .38). The 95% confidence intervals of spironolactone's effect on peak VO2 (-8.2% to 3.2%) excluded a clinically significant beneficial effect. There were also no significant differences in 6-minute walk distance, arterial stiffness, left ventricular (LV) mass, LV mass/end-diastolic volume, or MLHFQ score. CONCLUSION: In older adults with stable compensated HFpEF, 9 months of spironolactone 25 mg/d was well tolerated and reduced BP but did not improve exercise capacity, quality of life, LV mass, or arterial stiffness. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/28542926/Effect_of_Spironolactone_on_Exercise_Tolerance_and_Arterial_Function_in_Older_Adults_with_Heart_Failure_with_Preserved_Ejection_Fraction_ L2 - https://doi.org/10.1111/jgs.14940 DB - PRIME DP - Unbound Medicine ER -