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

Citation

Hare, JL and Sharman, JE and Leano, R and Jenkins, C and Wright, L and Marwick, TH, Impact of spironolactone on vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise, American Journal of Hypertension, 26, (5) pp. 691-699. ISSN 0895-7061 (2013) [Refereed Article]

Copyright Statement

Copyright 2013 American Journal of Hypertension

DOI: doi:10.1093/ajh/hpt008

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 (549 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 13310mm Hg and peak-exercise SBP was 21916mm Hg. Peak systolic strain (0.33.6% vs. -0.13.2, P = 0.56), E/em (-1.12.3 vs. -0.61.7, P = 0.30), VO2max (0.44.9 vs. -0.94.1ml/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 (-0.32.4 vs. 0.82.8, P = 0.06) and became significant after adjustment for baseline differences (P = 0.01). Patients with higher LVMI significantly increased VO2max (1.15.6 vs. -2.44.4ml/kg/min, P < 0.05) and reduced exercise E/em (-0.72.7 vs. 1.92.8, 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.

Item Details

Item Type:Refereed Article
Keywords:aldosterone antagonist; blood pressure; hypertension; echocardiography; exercise; left ventricular hypertrophy
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Sharman, JE (Professor James Sharman)
Author:Marwick, TH (Professor Tom Marwick)
ID Code:84225
Year Published:2013
Web of Science® Times Cited:8
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-04-30
Last Modified:2014-04-17
Downloads:0

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