| Effects of spironolactone on exercise capacity and neurohormonal factors in patients with heart failure treated with loop diuretics and angiotensin-converting enzyme inhibitor. | |
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MedLine Citation:
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PMID: 9595286 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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1. Treatment with spironolactone is reported to be useful when combined with loop diuretics and an angiotensin-converting enzyme (ACE) inhibitor in severe congestive heart failure (CHF). However, the effects of the addition of spironolactone on exercise capacity and neurohormonal variables have not been demonstrated. This study determined the effects of additive spironolactone on exercise capacity and neurohormonal factors in patients with mild CHF. 2. Oxygen uptake (VO2), plasma norepinephrine (NE), renin activity (PRA), angiotensin II (AII), aldosterone (ALD), and atrial natriuretic peptide (ANP) were measured at rest and after peak exercise in nine patients with CHF (six idiopathic and three ischemic cardiomyopathy; New York Heart Association (NYHA) classes II and III) who were already taking furosemide (mean 29 +/- 5 mg/day) and enalapril (mean 4.7 +/- 0.8 mg/day). Studies were repeated after 16 weeks of treatment with additive single daily dose of 25 mg of spironolactone. In four of nine patients, the exercise test was repeated after a 4-weeks washout of spironolactone. 3. Treatment with spironolactone caused natriuresis, decreased cardiothoracic ratio in chest X-ray (before vs. after treatment: 53.7 +/- 1.2 vs. 50.7 +/- 1.4%, P < 0.01), and improved NYHA functional class. Peak VO2 (17.1 +/- 1.6 vs. 17.5 +/- 2.2 ml/min/kg, NS) and heart rate and blood pressure responses to exercise were not altered. Resting NE (215 +/- 41 vs. 492 +/- 85 pg/ml, P < 0.01) and resting PRA (8.2 +/- 2.3 vs. 16.2 +/- 4.1 ng/ml/hr, P < 0.01) as well as peak NE (1618 +/- 313 vs. 2712 +/- 374 pg/ml, P < 0.01) and peak PRA (12.8 +/- 3.2 vs. 28.1 +/- 11.8 ng/ml/hr, P = 0.17) were augmented after additive spironolactone. ALD and AII were insignificantly increased, and ANP was insignificantly decreased at peak exercise after spironolactone treatment. Spironolactone washout was associated with a trend of the neurohormones to return toward pretreatment values. 4. In conclusion, chronic additive treatment with spironolactone was associated with neurohormonal activation both at rest and during exercise without changing the exercise capacity of patients with mild CHF who were already on loop diuretics and ACE inhibitor therapy. |
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Authors:
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T Kinugawa; K Ogino; M Kato; Y Furuse; M Shimoyama; M Mori; A Endo; T Kato; H Omodani; S Osaki; H Miyakoda; I Hisatome; C Shigemasa |
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Publication Detail:
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Type: Clinical Trial; Controlled Clinical Trial; Journal Article |
Journal Detail:
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Title: General pharmacology Volume: 31 ISSN: 0306-3623 ISO Abbreviation: Gen. Pharmacol. Publication Date: 1998 Jul |
Date Detail:
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Created Date: 1998-08-05 Completed Date: 1998-08-05 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7602417 Medline TA: Gen Pharmacol Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 93-9 Citation Subset: IM |
Affiliation:
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First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan. kinugawa@grape.med.tottori-u.ac.jp |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Angiotensin-Converting Enzyme Inhibitors / therapeutic use* Diuretics / pharmacology* Echocardiography Electrolytes / urine Exercise Test Female Heart Failure / drug therapy* Humans Male Middle Aged Neurosecretory Systems / drug effects* Pulmonary Ventilation Spironolactone / therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Angiotensin-Converting Enzyme Inhibitors; 0/Diuretics; 0/Electrolytes; 52-01-7/Spironolactone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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