Effects of spironolactone on exercise blood pressure in patients at increased risk of developing heart failure: report from the HOMAGE trial

Wei, Fang Fei; Pellicori, Pierpaolo; Ferreira, João Pedro; González, Arantxa; Mariottoni, Beatrice; An, De Wei; Verdonschot, Job A.J.; Liu, Chen; Ahmed, Fozia Z.; Petutschnigg, Johannes; Rossignol, Patrick; Heymans, Stephane; Cuthbert, Joe; Girerd, Nicolas; Clark, Andrew L.; Li, Yan; Nawrot, Tim S.; Díez, Javier; Zannad, Faiez; Cleland, John G.F.; Staessen, Jan A.; Zannad, Faiez; Wei, Fang Fei; Verdonschot, Job A.J.; Thijs, Lutgarde; Ravassa, Suzanna; Rouet, Philippe; Rossignol, Patrick; Pellicori, Pierpaolo; Pieske, Burkert; Pizard, Anne; Mamas, Mamas A.; Moreno, María U.; Maestre, Gladys E.; McDonald, Ken; Latini, Roberto; López, Begoñia; Khan, Javed; Hansen, Tine W.; Heymans, Stephane; Hazebroek, Mark; Grojean, Stephanie; Girerd, Nicolas; Ferreira, João P.; Edelmann, Frank; Díez, Javier; Collier, Tim; Cleland, John G.F.; Cosmi, Franco; Brunner La Rocca, Hans P.; Bozec, Erwan; Asayama, Kei

Abstract

None of the spironolactone trials in heart failure (HF) assessed the blood pressure (BP) responses to exercise, while conflicting results were reported for exercise capacity. In the HOMAGE trial, 527 patients at increased HF risk were randomized to usual treatment with or without spironolactone (25–50 mg/day). The current substudy included 113 controls and 114 patients assigned spironolactone, who all completed the incremental shuttle walk test at baseline and months 1 and 9. Quality of life (QoL) was assessed by EQ5D questionnaire. Between-group differences (spironolactone minus control [Δs]) were analyzed by repeated measures ANOVA with adjustment for baseline and, if appropriate, additionally for sex, age and body mass index. Δs in the pre-exercise systolic/diastolic BP were −8.00 mm Hg (95% CI, −11.6 to −4.43)/−0.85 mm Hg (−2.96 to 1.26) at month 1 and −9.58 mm Hg (−14.0 to −5.19)/−3.84 mm Hg (−6.22 to −1.47) at month 9. Δs in the post-exercise systolic/diastolic BP were −8.08 mm Hg (−14.2 to −2.01)/−2.07 mm Hg (−5.79 to 1.65) and −13.3 mm Hg (−19.9 to −6.75)/−4.62 mm Hg (−8.07 to −1.17), respectively. For completed shuttles, Δs at months 1 and 9 were 2.15 (−0.10 to 4.40) and 2.49 (−0.79 to 5.67), respectively. Δs in QoL were not significant. The correlations between the exercise-induced BP increases and the number of completed shuttles were similar in both groups. In conclusion, in patients at increased risk of developing HF, spironolactone reduced the pre- and post-exercise BP, but did not improve exercise capacity or QoL. (Figure presented.)

Citation

Wei, F. F., Pellicori, P., Ferreira, J. P., González, A., Mariottoni, B., An, D. W., Verdonschot, J. A., Liu, C., Ahmed, F. Z., Petutschnigg, J., Rossignol, P., Heymans, S., Cuthbert, J., Girerd, N., Clark, A. L., Li, Y., Nawrot, T. S., Díez, J., Zannad, F., Cleland, J. G., …Asayama, K. (2024). Effects of spironolactone on exercise blood pressure in patients at increased risk of developing heart failure: report from the HOMAGE trial. Hypertension Research, https://doi.org/10.1038/s41440-024-01843-z

• Journal Article Type: Article
• Acceptance Date: Jul 23, 2024
• Publication Date: Jan 1, 2024
• Deposit Date: Oct 24, 2024
• Publicly Available Date: Oct 28, 2024
• Journal: Hypertension Research
• Print ISSN: 0916-9636
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1038/s41440-024-01843-z
• Public URL: https://hull-repository.worktribe.com/output/4868443