Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure

Mottram, P.; Haluska, Brian; Leano, Rodel; Cowley, Diane; Stowasser, Michael; Marwick, Thomas H.

doi:10.1161/01.cir.0000138680.89536.a9

Cited by 263 publications

(152 citation statements)

References 48 publications

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“…Furthermore, MRAs have been shown to improve CV outcomes in subjects with HFREF 15, 16, 17, 18, 19. Several studies have evaluated the efficacy and safety of MRAs in patients with asymptomatic LVDD20, 21, 22, 23, 24 as well as established HFPEF 25, 26, 27, 28, 29, 30…”

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confidence: 99%

Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta‐Analysis and Systematic Review

Pandey

Garg

Matulevicius

et al. 2015

JAHA

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BackgroundThere has been an increasing interest in use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with preserved ejection fraction (HFPEF). However, a comprehensive evaluation of MRA effects on left ventricular (LV) structure and function in these patients is lacking. In this meta‐analysis, we evaluated the effects of MRAs on LV structure and function among patients with diastolic dysfunction or HFPEF.Methods & ResultsRandomized, controlled clinical trials evaluating the efficacy of MRAs in patients with diastolic dysfunction or HFPEF were included. The primary outcome was change in E/e’, a specific measure of diastolic function. Secondary outcomes included changes in other measures of diastolic function, LV structure, surrogate markers for myocardial fibrosis (carboxy‐terminal peptide of procollagen type I [PICP] and amino‐terminal peptide of pro‐collagen type‐II [PIIINP]), blood pressure, and exercise tolerance. In the pooled analysis, MRA use was associated with significant reduction in E/e’ (weighted mean difference [WMD] [95% confidence interval {CI}]: −1.68 [−2.03 to −1.33]; P<0.0001) and deceleration time (WMD [95% CI]: −12.0 ms [−23.3 to −0.7]; P=0.04) as compared with control, suggesting and improvement in diastolic function. Furthermore, blood pressure and levels of PIIINP and PICP were also significantly reduced with MRA therapy with no significant change in LV mass or dimensions.Conclusion MRA therapy in patients with asymptomatic diastolic dysfunction or HFPEF is associated with significant improvement in diastolic function and markers of cardiac fibrosis without a significant change in LV mass or dimensions.

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confidence: 99%

Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta‐Analysis and Systematic Review

Pandey

Garg

Matulevicius

et al. 2015

JAHA

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“…12 It has also been recently shown to improve systolic performance in hypertensives with diastolic heart failure. 13 The subjects included in these studies were relatively young, with a mean age of 53 ± 3 years in the study by Sato et al 12 and 62 ± 6 years in the study by Mottram et al 13 Although hypertension was present in the majority of our subjects, almost half of them did not have left ventricular hypertrophy. Since hypertension is quite prevalent in the elderly, 14 excluding patients with hypertension from our study would have significantly limited potential subjects, and the result Abbreviations: SBP = systolic blood pressure, DBP = diastolic blood pressure, HR = heart rate.…”

Section: Discussionmentioning

confidence: 69%

Spironolactone improves diastolic function in the elderly

Roongsritong¹,

Sutthiwan²,

Bradley³

et al. 2005

Clin Cardiol

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SummaryBackground: Diastolic dysfunction is common in the elderly. Increased myocardial fibrosis, a major determinant of diastolic function, has been observed with advancing age. Spironolactone prevents age-related increases in myocardial fibrosis in old normotensive rats.Hypothesis: Spironolactone, via its antifibrotic activity, can improve diastolic function in the elderly with isolated diastolic dysfunction.Methods: The study was a prospective, double-blind, randomized, placebo-controlled trial. Thirty elderly subjects between 60 and 85 years of age with isolated diastolic dysfunction and no contraindications for spironolactone were randomized to 25 mg/day of spironolactone or placebo for 4 months. Mitral E/A and deceleration time, plasma levels of carboxy-terminal of procollagen type I (PICP), and brain natriuretic peptide (BNP) were measured at baseline and at the end of 4 months. Plasma level of potassium was also monitored to prevent clinically significant hyperkalemia.Results: There was no serious adverse event or clinically significant hyperkalemia in the spironolactone group. Compared with baseline values, spironolactone significantly improved mitral E/A ratio (0.71 ± 0.08 vs. 0.84 ± 0.19, p = 0.025) and deceleration time (285.5 ± 73.1 vs. 230.0 ± 54.7, p = 0.035). There were no significant differences in the magnitude

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“…En el mismo modelo, se señaló que los ARM son capaces de inhibir el remodelamiento miocárdico y prevenir el desarrollo de ICD 24 . Ensayos clínicos, de pequeño tamaño muestral, en pacientes con ICD que recibieron junto al tratamiento convencional canrenona, espironolactona o eplerenona demostraron una mejora de los parámetros ecocardiográficos de disfunción diastólica, con mejoras en la sintomatología y la calidad de vida, y sin modificar significativamente los valores de masa ventricular, presión arterial o capacidad aeróbica respecto a grupos control [25][26][27][28][29] . Además se encontró una disminución significativa de marcadores de síntesis del colágeno en el grupo tratado con eplerenona por 6 meses 29 .…”

Section: Arm En Insuficiencia Cardiaca Diastólicaunclassified

“…Lamentablemente, el efecto antihipertensivo requiere de dosis de 100-500 mg/día, asociadas a un mayor riesgo de hiperkalemia 55,56 . Sin embargo, estudios en población hipertensa con dosis bajas de espironolactona añadido a IECA/ARA2 han señalado una mejora de la función ventricular izquierda 26 . Un ensayo clínico con distribución aleatoria en pacientes con HTA esencial (n = 409), comparando diversas dosis de eplerenona (50-400 mg/día) contra placebo y espironolactona (100 mg/día), reportó una reducción significativa de la presión arterial sistólica y diastólica en todos los grupos tratados con ARM versus placebo (p < 0,05) 57 .…”

Section: Arm En Hipertensión Arterialunclassified

Aplicaciones y proyecciones de los antagonistas del receptor de mineralocorticoides en el tratamiento de patologías cardiovasculares

et al. 2014

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Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure

Abstract: Aldosterone antagonism improves myocardial function in hypertensive heart disease.

Cited by 263 publications

References 48 publications

Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta‐Analysis and Systematic Review

Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta‐Analysis and Systematic Review

Spironolactone improves diastolic function in the elderly

Aplicaciones y proyecciones de los antagonistas del receptor de mineralocorticoides en el tratamiento de patologías cardiovasculares

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