Abstract 4853: Spironolactone Therapy is Associated With Rapid Improvements in Blood Pressure Control and Cardiac Remodeling in Patients With Resistant Hypertension
Background: The addition of spironolactone to a multidrug regimen is emerging as an effective antihypertensive strategy in patients with resistant hypertension independent of underlying aldosterone status. The effect of spironolactone on cardiac remodeling in these patients is not clear however.
Aims: In the current prospective study we used 3D-magnetic resonance imaging (MRI) to accurately evaluate the effects of spironolactone therapy on cardiac remodeling in patients with resistant hypertension.
Methods and Results: Twenty-two resistant hypertension patients were evaluated by MRI, prior to, and then 3 and 6 months following addition of spironolactone to a multidrug regime (all were taking at least 3 antihypertensives including a diuretic). Patients had a mean age of 54±2 years, 27% were female, 27% were African American and mean left ventricular (LV) ejection fraction was 70±1%. At three-months following spironolactone therapy, systolic and diastolic blood pressures were significantly improved (141±3 vs. 122±2, p<0.001 and 85±3 vs. 77±2, p=0.002, respectively). Furthermore significant reductions were noted in LV mass index (86±3 vs. 72±3, p<0.001), LA volume index (46±3 vs. 39±2, p=0.003) and BNP levels (44±9 vs. 17±5, p=0.009). Reductions in blood pressures, LV mass index and LA volumes remained significant independent of underlying aldosterone status. At six-months, there were no significant further reductions in any of these parameters.
Conclusions: In addition to a marked antihypertensive effect, addition of spironolactone to a multidrug regimen is associated with rapid regression of LV hypertrophy and reductions in LA volumes and BNP, all of which are important prognostic indicators. These findings demonstrate the broad cardiovascular benefits associated with spironolactone therapy in patients with resistant hypertension.