Spironolactone has beneficial BP lowering effect in patients with heart failure risk

Uncontrolled blood pressure (BP) increases the risk of developing heart failure (HF). The effect of spironolactone on the BP of patients at risk of developing HF is yet to be determined.

Hence, João Pedro Ferreira and colleagues from the Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique, France conducted the present study with the aim to evaluate the effect of spironolactone on the BP of patients at risk for HF and whether renin can predict spironolactone's effect.

The authors conducted a HOMAGE (Heart OMics in Aging) trial, which was a prospective multicentre randomized open-label blinded endpoint (PROBE) trial. The study included a total of 527 patients, all of whom were at risk for developing HF.

The sample was randomly assigned to either spironolactone (25–50 mg/day) or usual care alone for a maximum of 9 months. Sitting BP was assessed at baseline, Months 1 and 9 (or last visit). Analysis of covariance (ANCOVA), mixed-effects models and structural modelling equations were used.

The median (percentile_25–75) age was 73 (69–79) years, 26% were female, and >75% had a history of hypertension. Overall, the baseline BP was 142/78 mmHg.

The key findings noted were-

a. 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).

b. Compared with usual care, by the 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).

c. A higher proportion of patients on spironolactone had controlled BP <130/80 mmHg (36 vs. 26%; P = 0.014).

d. Lower baseline renin levels predicted a greater response to spironolactone (interaction P = 0.041).

Therefore, the authors concluded that "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."