title: Impact of spironolactone on vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise.
abstract: BACKGROUND
  Although a hypertensive response to exercise (HRE) is associated with cardiac risk and masked hypertension (MHT), its mechanisms and appropriate treatment remain unclear. We investigated spironolactone as a treatment for abnormal vascular and myocardial stiffness in HRE.
  
  
  METHODS
  In this randomized, double-blind, placebo-controlled study of 115 patients (54 ± 9 years, 57% men) with an HRE (≥210/105 mm Hg in men; ≥190/105 mm Hg in women) but no prior history of hypertension or myocardial ischemia, MHT prevalence was 40%. Patients were randomized to spironolactone 25mg daily (n = 58) or placebo (n = 57) and underwent evaluation at baseline and 3 months with exercise echocardiography, VO2max, pulse wave velocity (PWV), exercise and central blood pressure (BP), and 24-hour ambulatory BP. Changes in left ventricular mass index (LVMI), Doppler-derived E/em ratio (LV filling pressure), and myocardial strain were assessed.
  
  
  RESULTS
  Baseline 24-hour systolic BP (SBP) was 133 ± 10 mm Hg and peak-exercise SBP was 219 ± 16 mm Hg. Peak systolic strain (0.3 ± 3.6% vs. -0.1 ± 3.2, P = 0.56), E/em (-1.1 ± 2.3 vs. -0.6 ± 1.7, P = 0.30), VO(2max) (0.4 ± 4.9 vs. -0.9 ± 4.1 ml/kg/min, P = 0.15), and adjusted PWV did not significantly change with treatment, despite reduction in exercise SBP, 24-hour SBP, and LVMI. The change in exercise E/em was of borderline significance (-0.3 ± 2.4 vs. 0.8 ± 2.8, P = 0.06) and became significant after adjustment for baseline differences (P = 0.01). Patients with higher LVMI significantly increased VO(2max) (1.1 ± 5.6 vs. -2.4 ± 4.4 ml/kg/min, P < 0.05) and reduced exercise E/e(m) (-0.7 ± 2.7 vs. 1.9 ± 2.8, P < 0.05).
  
  
  CONCLUSIONS
  In HRE patients without previous hypertension, short-term spironolactone reduced exercise BP, 24-hour ambulatory BP, LVMI, and E/e(m) but did not significantly alter exercise capacity or myocardial strain.
authors: School of Medicine, The University of Queensland, Brisbane, Australia.
authors: James L
authors: JL
authors: Hare
authors: James E
authors: JE
authors: Sharman
authors: Rodel
authors: R
authors: Leano
authors: Carly
authors: C
authors: Jenkins
authors: Leah
authors: L
authors: Wright
authors: Thomas H
authors: TH
authors: Marwick
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002319:Cardiovascular System / Q000187:drug effects* / Q000503:physiopathology; D004311:Double-Blind Method; D015150:Echocardiography, Doppler; D015444:Exercise / Q000502:physiology*; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D059468:Masked Hypertension / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology*; D015995:Prevalence; D063177:Pulse Wave Analysis; D013148:Spironolactone / Q000494:pharmacology*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone