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Effect of spironolactone on diastolic function in hypertensive left ventricular hypertrophy

Journal of Human Hypertension volume 29, pages 241–246 (2015)Cite this article

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Abstract

We have previously shown rapid reversal of left ventricular hypertrophy (LVH) with 6 months of spironolactone therapy in patients with resistant hypertension (HTN), preserved left ventricular ejection fraction and no history of heart failure. In this substudy, we investigated the effect of mineralocorticoid receptor blockade with spironolactone on pre-clinical diastolic dysfunction. Thirty-four patients (19 with high and 15 with normal aldosterone levels) were treated with spironolactone and followed with cardiac magnetic resonance with tissue tagging at baseline, 3 and 6 months of treatment. Serum markers of collagen turnover (C-propeptide of type-I procollagen and carboxy-terminal telopeptide of type-I collagen) were measured at baseline and at 6 months. At baseline, patients demonstrated reduced E/A ratio (volumetric normalized peak early filling rate/late filling rate, normalized to left ventricular end-diastolic volume), lower peak early-diastolic mitral annular velocity and lower peak early-diastolic circumferential strain rates compared to the reference values obtained from 45 normal controls without HTN or cardiac disease (all comparisons, P<0.01). No significant change occurred in diastolic filling, relaxation parameters or collagen markers with spironolactone therapy at 6 months irrespective of aldosterone status despite significant reduction in left ventricular mass index in both high- and normal-aldosterone groups. In conclusion, resistant HTN patients with LVH demonstrate significant pre-clinical diastolic dysfunction. Short-term spironolactone therapy may not lead to improvement in diastolic function despite rapid reversal of LVH.

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Acknowledgements

This study was funded by NIH grants P50-HL077100 (to LJD) and R01-HL104018 (to HG).

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Authors and Affiliations

  1. Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    A Gupta, C G Schiros, K K Gaddam, S G Lloyd, S Oparil, L J Dell'Italia, D A Calhoun & H Gupta

  2. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA

    I Aban

  3. Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA

    T S Denney

  4. Birmingham Veteran Affairs Medical Center, Birmingham, AL, USA

    S G Lloyd, L J Dell'Italia & H Gupta

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  1. A Gupta
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  2. C G Schiros
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Correspondence to H Gupta.

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Gupta, A., Schiros, C., Gaddam, K. et al. Effect of spironolactone on diastolic function in hypertensive left ventricular hypertrophy. J Hum Hypertens 29, 241–246 (2015). https://doi.org/10.1038/jhh.2014.83

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