Impact of spironolactone on vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise

Hare, James L., Sharman, James E., Leano, Rodel, Jenkins, Carly, Wright, Leah and Marwick, Thomas H. (2013) Impact of spironolactone on vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise. American Journal of Hypertension, 26 5: 691-699. doi:10.1093/ajh/hpt008


Author Hare, James L.
Sharman, James E.
Leano, Rodel
Jenkins, Carly
Wright, Leah
Marwick, Thomas H.
Title Impact of spironolactone on vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise
Journal name American Journal of Hypertension   Check publisher's open access policy
ISSN 0895-7061
1941-7225
Publication date 2013-05
Year available 2013
Sub-type Article (original research)
DOI 10.1093/ajh/hpt008
Open Access Status DOI
Volume 26
Issue 5
Start page 691
End page 699
Total pages 9
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2014
Language eng
Formatted 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.
Keyword Aldosterone antagonist
Blood pressure
Hypertension
Echocardiography
Exercise
Left ventricular hypertrophy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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