PMID- 19104723
OWN - NLM
STAT- MEDLINE
DCOM- 20090320
LR  - 20211020
IS  - 1995-1892 (Print)
IS  - 1680-0745 (Electronic)
IS  - 1015-9657 (Linking)
VI  - 19
IP  - 6
DP  - 2008 Nov-Dec
TI  - A randomised, controlled, double-blind, cross-over pilot study assessing the 
      effects of spironolactone, losartan and their combination on heart rate 
      variability and QT dispersion in patients with chronic heart failure.
PG  - 292-6
AB  - BACKGROUND AND OBJECTIVE: The blocking of aldosterone or angiotensin II receptors 
      improves mortality in patients with chronic heart failure. We explored whether 
      combining losartan and spironolactone would have any added benefit on the known 
      surrogate of mortality by using heart rate variability (HRV) and QT dispersion as 
      our endpoints. METHODS: We designed a three-phase, consecutive, randomised, 
      controlled, double-blind, cross-over pilot study to assess the effects of 
      losartan alone (50 mg/day), spironolactone (25 mg/day) with angiotensin 
      converting enzyme (ACE) inhibitor and, finally, losartan with spironolactone, on 
      HRV and QT dispersion. We enrolled eight patients (aged 47 to 72 years, mean = 
      63.7 years), with New York Heart Association (NYHA) class II-III heart failure 
      and ejection fraction (EF) < 35%, in the study at a university-affiliated 
      hospital in Dundee, Scotland. Digital 24-hour Holter recordings were analysed for 
      time-domain HRV and the 12-lead ECG was optically scanned and digitised for 
      analysis of QT dispersion. Evaluations were done at baseline, and at six, 12 and 
      18 weeks from baseline. RESULTS: Losartan and spironolactone showed statistically 
      significant, favourable effects on HRV, QT dispersion and mean heart rate (p < 
      0.05). CONCLUSION: The data showed that in these patients with heart failure, the 
      addition of spironolactone to an ACE inhibitor, or the use of losartan on its 
      own, or the combination of losartan plus spironolactone induced a favourable 
      sympathovagal balance. The drugs significantly improved HRV indices and QT 
      dispersion further, and the combination appeared to be safe. However, no 
      significant differences were seen between the effects of each of these regimes on 
      HRV and QT dispersion.
FAU - Shehab, A
AU  - Shehab A
AD  - Department of Internal Medicine, Faculty of Medicine and Health Sciences, United 
      Arab Emirates University, Al Ain, United Arab Emirates.
FAU - Elnour, A A
AU  - Elnour AA
FAU - Struthers, A D
AU  - Struthers AD
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - South Africa
TA  - Cardiovasc J Afr
JT  - Cardiovascular journal of Africa
JID - 101313864
RN  - 0 (Angiotensin II Type 1 Receptor Blockers)
RN  - 0 (Mineralocorticoid Receptor Antagonists)
RN  - 27O7W4T232 (Spironolactone)
RN  - JMS50MPO89 (Losartan)
SB  - IM
MH  - Action Potentials
MH  - Adult
MH  - Aged
MH  - Angiotensin II Type 1 Receptor Blockers/*therapeutic use
MH  - Chronic Disease
MH  - Cross-Over Studies
MH  - Double-Blind Method
MH  - Drug Therapy, Combination
MH  - Electrocardiography, Ambulatory
MH  - Female
MH  - Heart Failure/*drug therapy/physiopathology
MH  - Heart Rate/*drug effects
MH  - Humans
MH  - Losartan/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Mineralocorticoid Receptor Antagonists/*therapeutic use
MH  - Pilot Projects
MH  - Signal Processing, Computer-Assisted
MH  - Spironolactone/*therapeutic use
MH  - Stroke Volume
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC3971616
EDAT- 2008/12/24 09:00
MHDA- 2009/03/21 09:00
PMCR- 2008/11/01
CRDT- 2008/12/24 09:00
PHST- 2008/12/24 09:00 [entrez]
PHST- 2008/12/24 09:00 [pubmed]
PHST- 2009/03/21 09:00 [medline]
PHST- 2008/11/01 00:00 [pmc-release]
PST - ppublish
SO  - Cardiovasc J Afr. 2008 Nov-Dec;19(6):292-6.