TY - JOUR
T1 - Spironolactone effect on the blood pressure of patients at risk of developing heart failure
T2 - an analysis from the HOMAGE trial
AU - Ferreira, João Pedro
AU - Collier, Timothy
AU - Clark, Andrew L
AU - Mamas, Mamas A
AU - Rocca, Hans-Peter Brunner-La
AU - Heymans, Stephane
AU - González, Arantxa
AU - Ahmed, Fozia Z
AU - Petutschnigg, Johannes
AU - Mujaj, Blerim
AU - Cuthbert, Joe
AU - Rouet, Philippe
AU - Pellicori, Pierpaolo
AU - Mariottoni, Beatrice
AU - Cosmi, Franco
AU - Edelmann, Frank
AU - Thijs, Lutgarde
AU - Staessen, Jan A
AU - Hazebroek, Mark
AU - Verdonschot, Job
AU - Rossignol, Patrick
AU - Girerd, Nicolas
AU - Cleland, John G
AU - Zannad, Faiez
N1 - © Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2021. For permissions, please email: [email protected].
PY - 2022/2/16
Y1 - 2022/2/16
N2 - BACKGROUND: Uncontrolled blood pressure (BP) increases the risk of developing heart failure (HF). The effect of spironolactone on BP of patients at risk of developing HF is yet to be determined.AIMS: To evaluate the effect of spironolactone on the BP of patients at risk for HF and whether renin can predict spironolactone`s effect.METHODS: HOMAGE (Heart OMics in Aging) was a prospective multicenter randomized open-label blinded Endpoint (PROBE) trial including 527 patients at risk for developing HF randomly assigned to either spironolactone (25-50mg/day) or usual care alone for a maximum of 9 months. Sitting BP was assessed at baseline, month 1 and 9 (or last visit). Analysis of covariance (ANCOVA), mixed effects models, and structural modelling equations were used.RESULTS: The median (percentile25-75) age was 73 (69-79) years, 26% were female, and >75% had history of hypertension. Overall, the baseline BP was 142/78 mmHg. Patients with higher BP were older, more likely to have diabetes and less likely to have coronary artery disease, had greater left ventricular mass (LVM), and left atrial volume (LAV). Compared with usual care, by last visit, spironolactone changed SBP by -10.3 (-13.0 to -7.5)mmHg and DBP by -3.2 (-4.8 to -1.7)mmHg (p < 0.001 for both). A higher proportion of patients on spironolactone had controlled BP < 130/80 mmHg (36 vs. 26%; p = 0.014). Lower baseline renin levels predicted a greater response to spironolactone (interactionp=0.041).CONCLUSION: Spironolactone had a clinically important BP-lowering effect. Spironolactone should be considered for lowering blood pressure in patients who are at risk of developing HF.
AB - BACKGROUND: Uncontrolled blood pressure (BP) increases the risk of developing heart failure (HF). The effect of spironolactone on BP of patients at risk of developing HF is yet to be determined.AIMS: To evaluate the effect of spironolactone on the BP of patients at risk for HF and whether renin can predict spironolactone`s effect.METHODS: HOMAGE (Heart OMics in Aging) was a prospective multicenter randomized open-label blinded Endpoint (PROBE) trial including 527 patients at risk for developing HF randomly assigned to either spironolactone (25-50mg/day) or usual care alone for a maximum of 9 months. Sitting BP was assessed at baseline, month 1 and 9 (or last visit). Analysis of covariance (ANCOVA), mixed effects models, and structural modelling equations were used.RESULTS: The median (percentile25-75) age was 73 (69-79) years, 26% were female, and >75% had history of hypertension. Overall, the baseline BP was 142/78 mmHg. Patients with higher BP were older, more likely to have diabetes and less likely to have coronary artery disease, had greater left ventricular mass (LVM), and left atrial volume (LAV). Compared with usual care, by last visit, spironolactone changed SBP by -10.3 (-13.0 to -7.5)mmHg and DBP by -3.2 (-4.8 to -1.7)mmHg (p < 0.001 for both). A higher proportion of patients on spironolactone had controlled BP < 130/80 mmHg (36 vs. 26%; p = 0.014). Lower baseline renin levels predicted a greater response to spironolactone (interactionp=0.041).CONCLUSION: Spironolactone had a clinically important BP-lowering effect. Spironolactone should be considered for lowering blood pressure in patients who are at risk of developing HF.
KW - Cardiovascular risk
KW - Hypertension
KW - Spironolactone
KW - Renin
KW - RESISTANT HYPERTENSION
KW - TASK-FORCE
KW - ALDOSTERONISM
KW - PREVENTION
KW - MANAGEMENT
KW - FIBROSIS
KW - IMPACT
U2 - 10.1093/ehjcvp/pvab031
DO - 10.1093/ehjcvp/pvab031
M3 - Article
C2 - 33822033
SN - 2055-6837
VL - 8
SP - 149
EP - 156
JO - European Heart Journal-Cardiovascular Pharmacotherapy
JF - European Heart Journal-Cardiovascular Pharmacotherapy
IS - 2
ER -