Spironolactone improves diastolic function in the elderly.
BACKGROUND
Diastolic dysfunction is common in the elderly. Increased myocardial fibrosis, a major determinant of diastolic function, has been observed with advancing age. Spironolactone prevents age-related increases in myocardial fibrosis in old normotensive rats.


OBJECTIVE
Spironolactone, via its antifibrotic activity, can improve diastolic function in the elderly with isolated diastolic dysfunction.


METHODS
The study was a prospective, double-blind, randomized, placebo-controlled trial. Thirty elderly subjects between 60 and 85 years of age with isolated diastolic dysfunction and no contraindications for spironolactone were randomized to 25 mg/day of spironolactone or placebo for 4 months. Mitral E/A and deceleration time, plasma levels of carboxy-terminal of procollagen type I (PICP), and brain natriuretic peptide (BNP) were measured at baseline and at the end of 4 months. Plasma level of potassium was also monitored to prevent clinically significant hyperkalemia.


RESULTS
There was no serious adverse event or clinically significant hyperkalemia in the spironolactone group. Compared with baseline values, spironolactone significantly improved mitral E/A ratio (0.71 +/- 0.08 vs. 0.84 +/- 0.19, p = 0.025) and deceleration time (285.5 +/- 73.1 vs. 230.0 +/- 54.7, p = 0.035). There were no significant differences in the magnitude of change in the levels of PICP and BNP between the two treatment groups.


CONCLUSIONS
Spironolactone may improve diastolic function in the elderly.
Roongsritong
Chanwit
C
Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX 79430-9410, USA. chanwit.roongsritong@ttuhsc.edu
Sutthiwan
Piraon
P
Bradley
Jason
J
Simoni
Jan
J
Power
Sherrie
S
Meyerrose
Gary E
GE
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D003971:Diastole / Q000187:drug effects* / Q000502:physiology; D004311:Double-Blind Method; D005260:Female; D005355:Fibrosis; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D011446:Prospective Studies; D013148:Spironolactone / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D000451:Mineralocorticoid Receptor Antagonists; D010446:Peptide Fragments; D011347:Procollagen; C042813:procollagen type I carboxy terminal peptide; D020097:Natriuretic Peptide, Brain; D013148:Spironolactone