Comparison of effects of aldosterone receptor antagonists spironolactone and eplerenone on cardiovascular outcomes and safety in patients with acute decompensated heart failure.

Abstract

Differences in the clinical impacts of the aldosterone receptor antagonists spironolactone and eplerenone in patients with heart failure (HF) are unclear. Among 838 prospectively enrolled patients hospitalized for HF, 90 treated with eplerenone were compared with 90 treated with spironolactone. The primary endpoint was a composite of cardiovascular death and hospitalization. A serial evaluation of the clinical parameters was performed 1 year after discharge. The mean dose of spironolactone was 27 ± 8 mg and of eplerenone was 34 ± 15 mg. During follow-up (mean 594 ± 317 days), primary endpoints occurred in 27 patients in the eplerenone group (30.0%) and 25 patients in the spironolactone group (27.8%). There were no significant intergroup differences in the primary endpoint (log-rank, p = 0.956). Serial changes in left ventricular ejection fraction, serum brain natriuretic peptide, systolic blood pressure, and estimated glomerular filtration rate did not differ significantly between groups. Although gynecomastia in men was common in the spironolactone group (p = 0.018), the discontinuation rates due to adverse events were similar in the two groups (p = 0.135). Subgroup analyses suggested that eplerenone was associated with a lower hazard rate of the primary endpoint in female patients (interaction, p = 0.076). Among patients with HF, eplerenone and spironolactone have similar impacts on cardiovascular outcomes and safety.

• Authors: Masayoshi Yamamoto, Yoshihiro Seo, Tomoko Ishizu, Isao Nishi, Yoshie Hamada-Harimura, Tomoko Machino-Ohtsuka, Haruhiko Higuchi, Seika Sai, Tomofumi Nakatsukasa, Akinori Sugano, Masako Baba, Kenichi Obara, Kazutaka Aonuma
• Journal: Heart and vessels (Heart Vessels) Vol. 34 Issue 2 Pg. 279-289 (Feb 2019) ISSN: 1615-2573 [Electronic] Japan
• PMID: 30203391 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study)

Chemical References

• Mineralocorticoid Receptor Antagonists
• Spironolactone
• Eplerenone

Topics

• Acute Disease
• Aged
• Eplerenone (therapeutic use)
• Female
• Follow-Up Studies
• Heart Failure (drug therapy, physiopathology)
• Humans
• Male
• Mineralocorticoid Receptor Antagonists (therapeutic use)
• Prospective Studies
• Spironolactone (therapeutic use)
• Time Factors
• Treatment Outcome
• Ventricular Function, Left (drug effects)