| Effect of aldosterone antagonism on myocardial dysfunction in hypertensive patients with diastolic heart failure. | |
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MedLine Citation:
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PMID: 15277317 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Specific treatments targeting the pathophysiology of hypertensive heart disease are lacking. As aldosterone has been implicated in the genesis of myocardial fibrosis, hypertrophy, and dysfunction, we sought to determine the effects of aldosterone antagonism on myocardial function in hypertensive patients with suspected diastolic heart failure by using sensitive quantitative echocardiographic techniques in a randomized, double-blinded, placebo-controlled study. METHODS AND RESULTS: Thirty medically treated ambulatory hypertensive patients (19 women, age 62+/-6 years) with exertional dyspnea, ejection fraction >50%, and diastolic dysfunction (E/A <1, E deceleration time >250 m/sec) and without ischemia were randomized to spironolactone 25 mg/d or placebo for 6 months. Patients were overweight (31+/-5 kg/m2) with reduced treadmill exercise capacity (6.7+/-2.1 METS). Long-axis strain rate (SR), peak systolic strain, and cyclic variation of integrated backscatter (CVIB) were averaged from 6 walls in 3 standard apical views. Mean 24-hour ambulatory blood pressure at baseline (133+/-17/80+/-7 mm Hg) did not change in either group. Values for SR, peak systolic strain, and CVIB were similar between groups at baseline and remained unchanged with placebo. Spironolactone therapy was associated with increases in SR (baseline: -1.57+/-0.46 s(-1) versus 6-months: -1.91+/-0.36 s(-1), P<0.01), peak systolic strain (-20.3+/-5.0% versus -26.9+/-4.3%, P<0.001), and CVIB (7.4+/-1.7 dB versus 8.6+/-1.7 dB, P=0.08). Each parameter was significantly greater in the spironolactone group compared with placebo at 6 months (P=0.05, P=0.02, and P=0.02, respectively), and the increases remained significant after adjusting for baseline differences. The increase in strain was independent of changes in blood pressure with intervention. The spironolactone group also exhibited reduction in posterior wall thickness (P=0.04) and a trend to reduced left atrial area (P=0.09). CONCLUSIONS: Aldosterone antagonism improves myocardial function in hypertensive heart disease. |
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Authors:
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Philip M Mottram; Brian Haluska; Rodel Leano; Diane Cowley; Michael Stowasser; Thomas H Marwick |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2004-07-26 |
Journal Detail:
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Title: Circulation Volume: 110 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2004 Aug |
Date Detail:
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Created Date: 2004-08-03 Completed Date: 2005-02-04 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 558-65 Citation Subset: AIM; IM |
Affiliation:
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University of Queensland, Brisbane, Australia. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aldosterone Antagonists / pharmacology*, therapeutic use Aorta / drug effects, physiopathology Compliance Diastole Dyspnea / etiology Exercise Test Exercise Tolerance / drug effects Female Heart Atria / drug effects, pathology Heart Failure / drug therapy*, etiology, physiopathology, ultrasonography Heart Ventricles / drug effects, pathology Humans Hypertension / complications, drug therapy*, physiopathology Male Middle Aged Myocardial Contraction / drug effects* Organ Size / drug effects Spironolactone / pharmacology*, therapeutic use Treatment Outcome Vascular Resistance / drug effects Ventricular Dysfunction, Left / drug therapy*, etiology, ultrasonography |
| Chemical | |
Reg. No./Substance:
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0/Aldosterone Antagonists; 52-01-7/Spironolactone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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