PMID- 9595286
OWN - NLM
STAT- MEDLINE
DCOM- 19980805
LR  - 20190826
IS  - 0306-3623 (Print)
IS  - 0306-3623 (Linking)
VI  - 31
IP  - 1
DP  - 1998 Jul
TI  - Effects of spironolactone on exercise capacity and neurohormonal factors in 
      patients with heart failure treated with loop diuretics and 
      angiotensin-converting enzyme inhibitor.
PG  - 93-9
AB  - 1. Treatment with spironolactone is reported to be useful when combined with loop 
      diuretics and an angiotensin-converting enzyme (ACE) inhibitor in severe 
      congestive heart failure (CHF). However, the effects of the addition of 
      spironolactone on exercise capacity and neurohormonal variables have not been 
      demonstrated. This study determined the effects of additive spironolactone on 
      exercise capacity and neurohormonal factors in patients with mild CHF. 2. Oxygen 
      uptake (VO2), plasma norepinephrine (NE), renin activity (PRA), angiotensin II 
      (AII), aldosterone (ALD), and atrial natriuretic peptide (ANP) were measured at 
      rest and after peak exercise in nine patients with CHF (six idiopathic and three 
      ischemic cardiomyopathy; New York Heart Association (NYHA) classes II and III) 
      who were already taking furosemide (mean 29 +/- 5 mg/day) and enalapril (mean 4.7 
      +/- 0.8 mg/day). Studies were repeated after 16 weeks of treatment with additive 
      single daily dose of 25 mg of spironolactone. In four of nine patients, the 
      exercise test was repeated after a 4-weeks washout of spironolactone. 3. 
      Treatment with spironolactone caused natriuresis, decreased cardiothoracic ratio 
      in chest X-ray (before vs. after treatment: 53.7 +/- 1.2 vs. 50.7 +/- 1.4%, P < 
      0.01), and improved NYHA functional class. Peak VO2 (17.1 +/- 1.6 vs. 17.5 +/- 
      2.2 ml/min/kg, NS) and heart rate and blood pressure responses to exercise were 
      not altered. Resting NE (215 +/- 41 vs. 492 +/- 85 pg/ml, P < 0.01) and resting 
      PRA (8.2 +/- 2.3 vs. 16.2 +/- 4.1 ng/ml/hr, P < 0.01) as well as peak NE (1618 
      +/- 313 vs. 2712 +/- 374 pg/ml, P < 0.01) and peak PRA (12.8 +/- 3.2 vs. 28.1 +/- 
      11.8 ng/ml/hr, P = 0.17) were augmented after additive spironolactone. ALD and 
      AII were insignificantly increased, and ANP was insignificantly decreased at peak 
      exercise after spironolactone treatment. Spironolactone washout was associated 
      with a trend of the neurohormones to return toward pretreatment values. 4. In 
      conclusion, chronic additive treatment with spironolactone was associated with 
      neurohormonal activation both at rest and during exercise without changing the 
      exercise capacity of patients with mild CHF who were already on loop diuretics 
      and ACE inhibitor therapy.
FAU - Kinugawa, T
AU  - Kinugawa T
AD  - First Department of Internal Medicine, Tottori University School of Medicine, 
      Yonago, Japan. kinugawa@grape.med.tottori-u.ac.jp
FAU - Ogino, K
AU  - Ogino K
FAU - Kato, M
AU  - Kato M
FAU - Furuse, Y
AU  - Furuse Y
FAU - Shimoyama, M
AU  - Shimoyama M
FAU - Mori, M
AU  - Mori M
FAU - Endo, A
AU  - Endo A
FAU - Kato, T
AU  - Kato T
FAU - Omodani, H
AU  - Omodani H
FAU - Osaki, S
AU  - Osaki S
FAU - Miyakoda, H
AU  - Miyakoda H
FAU - Hisatome, I
AU  - Hisatome I
FAU - Shigemasa, C
AU  - Shigemasa C
LA  - eng
PT  - Clinical Trial
PT  - Controlled Clinical Trial
PT  - Journal Article
PL  - England
TA  - Gen Pharmacol
JT  - General pharmacology
JID - 7602417
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Diuretics)
RN  - 0 (Electrolytes)
RN  - 27O7W4T232 (Spironolactone)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
MH  - Diuretics/*pharmacology
MH  - Echocardiography
MH  - Electrolytes/urine
MH  - Exercise Test
MH  - Female
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neurosecretory Systems/*drug effects
MH  - Pulmonary Ventilation
MH  - Spironolactone/*therapeutic use
EDAT- 1998/05/22 00:00
MHDA- 1998/05/22 00:01
CRDT- 1998/05/22 00:00
PHST- 1998/05/22 00:00 [pubmed]
PHST- 1998/05/22 00:01 [medline]
PHST- 1998/05/22 00:00 [entrez]
AID - S0306362397003960 [pii]
AID - 10.1016/s0306-3623(97)00396-0 [doi]
PST - ppublish
SO  - Gen Pharmacol. 1998 Jul;31(1):93-9. doi: 10.1016/s0306-3623(97)00396-0.