Mixed Results For Spironolactone In Heart Failure With Preserved Ejection Fraction

Although the mineralocorticoid receptor antagonists (MRAs) spironolactone and eplerenone (Inspra, Pfizer) have been shown to be beneficial in patients with heart failure (HF) with reduced ejection fraction (EF), their role in heart failure patients with preserved EF has not been tested until now. Now the results of the Aldo-DHF (Aldosterone Receptor Blockade in Diastolic Heart Failure), published in the Journal of the American Medical Association, demonstrate that although the treatment works as expected to improve diastolic function in this patient population, no clinical benefits were observed in association with these changes.

422 patients in Germany and Austria with NYHA class II or III heart failure with preserved LVEF were randomized to spironolactone or placebo for one year.  Compared with placebo, spironolactone was associated with improvements in LV end-diastolic filling, LV remodeling, and neurohumoral activation. However, there were no significant differences in maximal exercise capacity or quality of life between the groups.

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