Spironolactone effect on the blood pressure of patients at risk of developing heart failure: an analysis from the HOMAGE trial

Ferreira, J. P. et al. (2022) Spironolactone effect on the blood pressure of patients at risk of developing heart failure: an analysis from the HOMAGE trial. European Heart Journal: Cardiovascular Pharmacotherapy, 8(2), pp. 149-156. (doi: 10.1093/ehjcvp/pvab031) (PMID:33822033)

Abstract

Background: Uncontrolled blood pressure (BP) increases the risk of developing heart failure (HF). The effect of spironolactone on BP of patients at risk of developing HF is yet to be determined. Aims: To evaluate the effect of spironolactone on the BP of patients at risk for HF and whether renin can predict spironolactone`s effect. Methods: HOMAGE (Heart OMics in Aging) was a prospective multicenter randomized open-label blinded Endpoint (PROBE) trial including 527 patients at risk for developing HF randomly assigned to either spironolactone (25-50mg/day) or usual care alone for a maximum of 9 months. Sitting BP was assessed at baseline, month 1 and 9 (or last visit). Analysis of covariance (ANCOVA), mixed effects models, and structural modelling equations were used. Results: The median (percentile25-75) age was 73 (69-79) years, 26% were female, and >75% had history of hypertension. Overall, the baseline BP was 142/78 mmHg. Patients with higher BP were older, more likely to have diabetes and less likely to have coronary artery disease, had greater left ventricular mass (LVM), and left atrial volume (LAV). Compared with usual care, by last visit, spironolactone changed SBP by -10.3 (-13.0 to -7.5)mmHg and DBP by -3.2 (-4.8 to -1.7)mmHg (p < 0.001 for both). A higher proportion of patients on spironolactone had controlled BP < 130/80 mmHg (36 vs. 26%; p = 0.014). Lower baseline renin levels predicted a greater response to spironolactone (interactionp=0.041). Conclusion: Spironolactone had a clinically important BP-lowering effect. Spironolactone should be considered for lowering blood pressure in patients who are at risk of developing HF.

• Item Type: Articles
• Additional Information: HOMAGE was funded by a grant from the European Union 7th Framework Programme for Research and Technological Development (HEALTH-F7-305507 HOMAGE (EU FP7 305507 http://www.homage-hf.eu). JPF, PR, NG, FZ are supported by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d’Avenir” program (reference: ANR-15-RHUS-0004), by the French PIA project “Lorraine Université d’Excellence” (reference: ANR-15-IDEX-04-LUE), Contrat de Plan Etat Lorraine IT2MP and FEDER Lorraine.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John and Pellicori, Dr Pierpaolo
• Authors: Ferreira, J. P., Collier, T., Clark, A. L., Mamas, M. A., Rocca, H.-P. B.-L., Heymans, S., González, A., Ahmed, F. Z., Petutschnigg, J., Mujaj, B., Cuthbert, J., Rouet, P., Pellicori, P., Mariottoni, B., Cosmi, F., Edelmann, F., Thijs, L., Staessen, J. A., Hazebroek, M., Verdonschot, J., Rossignol, P., Girerd, N., Cleland, J. G., and Zannad, F.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Heart Journal: Cardiovascular Pharmacotherapy
• Publisher: Oxford University Press
• ISSN: 2055-6837
• ISSN (Online): 2055-6845
• Published Online: 02 April 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in European Heart Journal: Cardiovascular Pharmacotherapy 8(2): 149-156
• Publisher Policy: Reproduced in accordance with the publisher copyright policy