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Effects of aldosterone receptor blockade in patients with mild-moderate heart failure taking a beta-blocker

Berry, C. and Murphy, N. and De Vito, G. and Galloway, S. and Seed, A. and Fisher, C. and Sattar, N. and Vallance, P. (2007) Effects of aldosterone receptor blockade in patients with mild-moderate heart failure taking a beta-blocker. European Journal of Heart Failure, 9 (4). pp. 429-434.

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Aims: Spironolactone improves prognosis in severe heart failure (HF). We investigated its effects in patients with mild–moderate HF treated with an ACE inhibitor and beta-blocker. Randomised, double-blind, parallel-group, 3-month comparison of placebo and spironolactone (25 mg daily) in 40 patients in New York Heart Association (NYHA) class I (20%), II (70%) or III (10%), with a left ventricular ejection fraction of <40%. The mean (standard error) changes from baseline in the spironolactone and placebo groups were, respectively: i) B-type natriuretic peptide (BNP) −53.4(22.2) pg/mL and +3.3(12.1) pg/mL, P=0.04, ii) pro-collagen type III N-terminal amino peptide (PIIINP) −0.6(0.2) μmol/L and +0.02(0.2) μmol/L, P=0.02 and iii) creatinine +10.7(3.2) μmol/L and −0.3(2.6) μmol/L, P=0.01. Compared with placebo, spironolactone therapy was associated with a reduction in self-reported health-related quality of life: change in visual analog score: −6 (3) vs. +6 (4); P=0.01. No differences were observed on other biochemical, neurohumoral, exercise and autonomic function assessments. In patients with mild–moderate HF, spironolactone reduced neurohumoral activation (BNP) and a marker of collagen turnover (PIIINP) but impaired renal function and quality of life. The benefit–risk ratio of aldosterone blockade in mild HF is uncertain and requires clarification in a large randomised trial.