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- Title
Impact of Spironolactone on Vascular, Myocardial, and Functional Parameters in Untreated Patients With a Hypertensive Response to Exercise.
- Authors
Hare, James L.; Sharman, James E.; Leano, Rodel; Jenkins, Carly; Wright, Leah; Marwick, Thomas H.
- Abstract
BACKGROUND Although a hypertensive response to exercise (HRE) is associated with cardiac risk and masked hypertension (MHT), its mechanisms and appropriate treatment remain unclear. We investigated spironolactone as a treatment for abnormal vascular and myocardial stiffness in HRE. METHODS In this randomized, double-blind, placebo-controlled study of 115 patients (54±9 years, 57% men) with an HRE (≥210/105mm Hg in men; ≥190/105mm Hg in women) but no prior history of hypertension or myocardial ischemia, MHT prevalence was 40%. Patients were randomized to spironolactone 25mg daily (n = 58) or placebo (n = 57) and underwent evaluation at baseline and 3 months with exercise echocardiography, VO2max, pulse wave velocity (PWV), exercise and central blood pressure (BP), and 24-hour ambulatory BP. Changes in left ventricular mass index (LVMI), Doppler-derived E/em ratio (LV filling pressure), and myocardial strain were assessed. RESULTS Baseline 24-hour systolic BP (SBP) was 133±10mm Hg and peak-exercise SBP was 219±16mm Hg. Peak systolic strain (0.3±3.6% vs. −0.1±3.2, P = 0.56), E/em (−1.1±2.3 vs. −0.6±1.7, P = 0.30), VO2max (0.4±4.9 vs. −0.9±4.1ml/kg/min, P = 0.15), and adjusted PWV did not significantly change with treatment, despite reduction in exercise SBP, 24-hour SBP, and LVMI. The change in exercise E/em was of borderline significance (−0.3±2.4 vs. 0.8±2.8, P = 0.06) and became significant after adjustment for baseline differences (P = 0.01). Patients with higher LVMI significantly increased VO2max (1.1±5.6 vs. −2.4±4.4ml/kg/min, P < 0.05) and reduced exercise E/em (−0.7±2.7 vs. 1.9±2.8, P < 0.05). CONCLUSIONS In HRE patients without previous hypertension, short-term spironolactone reduced exercise BP, 24-hour ambulatory BP, LVMI, and E/em but did not significantly alter exercise capacity or myocardial strain.
- Subjects
SPIRONOLACTONE; HYPERTENSION risk factors; DRUG efficacy; ISCHEMIA; PLACEBOS
- Publication
American Journal of Hypertension, 2013, Vol 26, Issue 5, p691
- ISSN
0895-7061
- Publication type
Article
- DOI
10.1093/ajh/hpt008