Spironolactone effective add-on in patients with HFpEF, resistant hypertension: JAHA
Tokyo, Japan: Spironolactone may be an effective add-on medication for patients with heart failure with preserved ejection fraction (HFpEF) with resistant hypertension already taking ACEIs/ARBs, CCBs, and diuretics, according to a recent study in the Journal of the American Heart Association.
According to the study, spironolactone use led to a decreased risk of heart failure hospitalization, all-cause mortality, and composite cardiovascular events. However, the trend was not observed in HFpEF patients without hypertension.
Tetsuro Tsujimoto, and Hiroshi Kajio from National Center for Global Health and Medicine, Tokyo, Japan, and colleagues aimed to assess whether spironolactone use leads to improved cardiovascular outcomes in patients with heart failure with preserved ejection fraction (HFpEF) with resistant hypertension. Resistant hypertension is a salt‐retaining condition possibly attributable to inappropriate aldosterone secretion.
For the purpose, the researchers conducted a secondary analysis of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial. It included patients with HFpEF, with (n=1004) and without (n=2437) resistant hypertension.
Resistant hypertension was defined as systolic blood pressure ≥130 mm Hg and/or diastolic blood pressure ≥80 mm Hg in a patient with hypertension, despite the concurrent use of a renin‐angiotensin system blocker (angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker), a calcium channel blocker, and a diuretic; or as those patients using ≥4 classes of antihypertensive medication.
The primary outcome was a composite of cardiovascular death, aborted cardiac arrest, or heart failure hospitalization.
Key findings of the study include:
- The risk of primary outcome events in patients with HFpEF withresistant hypertension was significantly lower in the spironolactone group than in the placebo group (HR, 0.70), whereas the risk of primary outcome events in patients with HFpEF without resistant hypertension was not significantly different between the 2 groups (HR, 1.00).
- There was a significant interaction between spironolactone use and resistant hypertension.
- Similar associations were also observed in patients with HFpEF from the Americas (United States, Canada, Brazil, and Argentina) only.
"Our findings demonstrate that spironolactone use may be an effective add‐on medication for patients with HFpEF with resistant hypertension who are already taking ACEIs/ARBs, CCBs, and diuretics," concluded the authors.
The study, "Spironolactone Use and Improved Outcomes in Patients With Heart Failure With Preserved Ejection Fraction With Resistant Hypertension," is published in the Journal of the American Heart Association.
DOI: https://www.ahajournals.org/doi/10.1161/JAHA.120.018827
