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Spironolactone aids LV function but not symptoms.


Spironolactone significantly improved left ventricular diastolic function and remodeling in a 1-year study of ambulatory patients who had heart failure with preserved ejection fraction, but that benefit did not translate into improvements in HF symptoms or quality of life, according to a report.

In a multicenter, double-blind clinical trial, 213 men and women aged 50 and older were randomly assigned to receive daily oral spironolactone and 209 to receive a matching placebo for 1 year. Patients on spironolactone had significantly increased LV ejection fraction, decreased LV end-diastolic diameter and LV mass index, and reduced systolic blood pressure, reported Dr. Burkert M. Pieske, professor and head of the department of cardiology at Medical University of Graz, Austria, and his associates.

The drug failed to improve HF symptoms, exercise capacity, depressive symptoms, or quality of life, compared with placebo. "Our study population may have been too young or too healthy, or the treatment period ... too short, for observing a translation of improved diastolic function into a clinical benefit," they said (JAMA 2013;309:781-91).

These results were presented at the annual meeting of the European Society of Cardiology in Munich last summer, and reported by this newspaper. Experts reacting to the news at the meeting ex pressed similar misgivings. "Patients had an increase in their potassium level, and even more concerning, they had a reduction in their glomerular filtration rate" averaging about 5 mL/min, said Dr. Stefan D. Anker of Charite Medical University in Berlin. Also, distance on the 6-minute walk test was "slightly decreased with spironolactone. Even though it was a small change of 15 m, it was statistically significant," he noted.

The study was supported by the German-Austrian Heart Failure Study Group and the German Competence Network of Heart Failure. The investigators reported numerous ties to industry.

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Author:Moon, Mary Ann
Publication:Family Practice News
Article Type:Brief article
Geographic Code:1USA
Date:Mar 15, 2013
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