Volume 32, Issue 150 (January & February 2024)                   J Adv Med Biomed Res 2024, 32(150): 16-22 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Assareh A R, Haybar H, Hamid K, Hesam S, Akiash N. Comparison of the Therapeutic Effects of Spironolactone at Doses of 25 and 50 mg in Patients with Systolic Heart Failure: A Randomized Clinical Trial. J Adv Med Biomed Res 2024; 32 (150) :16-22
URL: http://journal.zums.ac.ir/article-1-7173-en.html
1- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2- Dept. of Cardiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3- Dept. of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran , akiash.n@gmail.com
Abstract:   (275 Views)

Background & Objective: Heart failure (HF), as the final stage of cardiovascular disease, is a prevalent cause of mortality, disability, and recurrent hospitalization. Effective treatment of systolic HF is crucial for reducing patient disability and preventing repeated hospital admissions. In this context, we aimed to conduct a comparative study of spironolactone at doses of 25 mg and 50 mg in patients with systolic HF.
Materials & Methods: This randomized clinical trial was performed on 100 patients with systolic HF. The patients were randomly divided into two treatment groups receiving 25 and 50 mg of spironolactone. Subsequently, changes in ejection fraction, frequency of hospitalization, performance capacity, quality of life, and electrolyte disorders were examined.
Results: There was no significant difference between the groups in terms of age, sex, cardiovascular risk factors, history of cerebrovascular accidents, readmission rate, and EF changes (P>0.05). At the end of the study, the mean scores of performance capacity and quality of life in patients receiving 50 mg of spironolactone were 204.3±28 and 32±3.1, respectively. These values were statistically higher than those reported in patients receiving 25 mg of spironolactone (178.9±30 and 36.7±3.3, respectively) (P<0.001). In patients who received 50 mg of spironolactone, the average levels of potassium and blood urea nitrogen were 0.68±0.08 and 6.1±1.4, respectively. These levels were significantly higher compared to those in patients receiving a 25mg dose, where the levels were 0.39±0.17 and 4.7±2.8, respectively (P<0.05). However, it is important to note that the maximum values observed did not exceed the normal range for these parameters.
Conclusion: Compared to the 25mg dose, the 50mg dose of spironolactone was observed to enhance both the quality of life and performance capacity in patients with systolic HF. Therefore, it can be prescribed as the initial daily dosage for managing patients with HF.

Full-Text [PDF 446 kb]   (115 Downloads)    
Type of Study: Original Article | Subject: Clinical medicine
Received: 2023/01/22 | Accepted: 2023/12/6 | Published: 2024/01/30

References
1. Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am College Cardiol. 2020;76(25):2982-3021. [DOI:10.1016/j.jacc.2020.11.010] [PMID] []
2. Warraich HJ, Hernandez AF, Allen LA. How medicine has changed the end of life for patients with cardiovascular disease. J Am College Cardiol. 2017;70(10):1276-89. [DOI:10.1016/j.jacc.2017.07.735] [PMID]
3. Heo S, Lennie TA, Okoli C, Moser DK. Quality of life in patients with heart failure: ask the patients. Heart Lung. 2009;38(2):100-8. [DOI:10.1016/j.hrtlng.2008.04.002] [PMID] []
4. Pihl E, Cider Å, Strömberg A, Fridlund B, Mårtensson J. Exercise in elderly patients with chronic heart failure in primary care: effects on physical capacity and health-related quality of life. Europ J Cardiovasc Nurs. 2011;10(3):150-8. [DOI:10.1016/j.ejcnurse.2011.03.002] [PMID]
5. Pitt B, Pedro Ferreira J, Zannad F. Mineralocorticoid receptor antagonists in patients with heart failure: current experience and future perspectives. Europ Heart J Cardiovasc Pharmacother. 2017;3(1):48-57. [DOI:10.1093/ehjcvp/pvw016] [PMID]
6. Hartupee J, Mann DL. Neurohormonal activation in heart failure with reduced ejection fraction. Nature Rev Cardiol. 2017;14(1):30-8. [DOI:10.1038/nrcardio.2016.163] [PMID] []
7. Miller AB. Aldosterone antagonism in heart failure. Vasc Health Risk Manage. 2007;3(5):605-9.
8. Vizzardi E, Regazzoni V, Caretta G, E, et al. Mineralocorticoid receptor antagonist in heart failure: Past, present and future perspectives. Int J Cardiol Heart Vessels. 2014;3:6-14. [DOI:10.1016/j.ijchv.2014.03.005] [PMID] []
9. Ziaeian B, Fonarow GC. The prevention of hospital readmissions in heart failure. Prog cardiovasc Dis. 2016;58(4):379-85. [DOI:10.1016/j.pcad.2015.09.004] [PMID] []
10. Kawano H, Node K. Medical agents acting on the renin-angiotensin-aldosterone axis for the treatment of heart failure. Hyperten Res. 2010;33(3):192-3. [DOI:10.1038/hr.2009.232] [PMID]
11. Pitt B, Zannad F, Remme WJ, Investigators RAES. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med.1999;341(10):709-17 [DOI:10.1056/NEJM199909023411001] [PMID]
12. Cicoira M, Zanolla L, Rossi A, et al. Long-term, dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure. J Am College Cardiol. 2002;40(2):304-10. [DOI:10.1016/S0735-1097(02)01965-4] [PMID]
13. Svensson M, Gustafsson F, Galatius S, Hildebrandt PR, Atar D. How prevalent is hyperkalemia and renal dysfunction during treatment with spironolactone in patients with congestive heart failure? J Cardiac Fail. 2004;10(4):297-303. [DOI:10.1016/j.cardfail.2003.10.012] [PMID]
14. Savarese G, Stolfo D, Sinagra G, Lund LH. Heart failure with mid-range or mildly reduced ejection fraction. Nature Rev Cardiol. 2022;19(2):100-16. [DOI:10.1038/s41569-021-00605-5] [PMID] []
15. Albert J, Lezius S, Störk S, et al. Trajectories of left ventricular ejection fraction after acute decompensation for systolic heart failure: concomitant echocardiographic and systemic changes, predictors, and impact on clinical outcomes. J Am Heart Assoc. 2021;10(3):e017822. [DOI:10.1161/JAHA.120.017822] [PMID] []
16. Rajaei E, Isfahani NP, Akiash N, Mohammadi M, Mowla K. Evaluation of the left ventricular function in patients with scleroderma with normal pulmonary artery pressure using myocardial strain analysis: A cross-sectional study. Int Cardiovasc Res J. 2022;16(4).
17. Arazi T, Aliasgharpour M, Mohammadi S, Mohammadi N, Kazemnejad A. Effect of a breathing exercise on respiratory function and 6-minute walking distance in patients under hemodialysis: a randomized controlled trial. J Nurs Res. 2021;29(2):e146. [DOI:10.1097/JNR.0000000000000423] [PMID]
18. Fields DL. Taking the measure of work: A guide to validated scales for organizational research and diagnosis: Sage; 2002. [DOI:10.4135/9781452231143]
19. Teichman SL, Maisel AS, Storrow AB. Challenges in acute heart failure clinical management: optimizing care despite incomplete evidence and imperfect drugs. Crit Pathway Cardiol. 2015;14(1):12. [DOI:10.1097/HPC.0000000000000031] [PMID] []
20. Rich MW. Heart failure disease management programs: efficacy and limitations. Am J Med. 2001;110(5):410-2. [DOI:10.1016/S0002-9343(01)00632-5] [PMID]
21. Chen Y, Wang H, Lu Y, Huang X, Liao Y, Bin J. Effects of mineralocorticoid receptor antagonists in patients with preserved ejection fraction: a meta-analysis of randomized clinical trials. BMC Med. 2015;13(1):1-12. [DOI:10.1186/s12916-014-0261-8] [PMID] []
22. Vizzardi E, D'Aloia A, Giubbini R, et al. Effect of spironolactone on left ventricular ejection fraction and volumes in patients with class I or II heart failure. Am J Cardiol. 2010;106(9):1292-6. [DOI:10.1016/j.amjcard.2010.06.052] [PMID]
23. Inampudi C, Parvataneni S, Morgan CJ, et al. Spironolactone use and higher hospital readmission for Medicare beneficiaries with heart failure, left ventricular ejection fraction< 45%, and estimated glomerular filtration rate< 45 ml/min/1.73 m2. Am J Cardiol. 2014;114(1):79-82. [DOI:10.1016/j.amjcard.2014.03.062] [PMID] []
24. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. New Engl J Med. 1999;341(10):709-17. [DOI:10.1056/NEJM199909023411001] [PMID]
25. Hoyt RE, Bowling LS. Reducing readmissions for congestive heart failure. Am Family Physic. 2001;63(8):1593-9.
26. Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Europ Heart J. 2014;35(7):455-69. [DOI:10.1093/eurheartj/eht386] [PMID]
27. Stubnova V, Os I, Grundtvig M, Atar D, Waldum-Grevbo B. Spironolactone treatment and effect on survival in chronic heart failure patients with reduced renal function: A propensity-matched study. Cardioren Med. 2017;7(2):128-36. [DOI:10.1159/000454933] [PMID] []

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Journal of Advances in Medical and Biomedical Research

Designed & Developed by : Yektaweb