Effects of spironolactone on exercise blood pressure in patients at increased risk of developing heart failure: report from the HOMAGE trial

None of the spironolactone trials in heart failure (HF) assessed the blood pressure (BP) responses to exercise, while conflicting results were reported for exercise capacity. In the HOMAGE trial, 527 patients at increased HF risk were randomized to usual treatment with or without spironolactone (25-50 mg/day). The current substudy included 113 controls and 114 patients assigned spironolactone, who all completed the incremental shuttle walk test at baseline and months 1 and 9. Quality of life (QoL) was assessed by EQ5D questionnaire. Between-group differences (spironolactone minus control [Δs]) were analyzed by repeated measures ANOVA with adjustment for baseline and, if appropriate, additionally for sex, age and body mass index. Δs in the pre-exercise systolic/diastolic BP were -8.00 mm Hg (95% CI, -11.6 to -4.43)/-0.85 mm Hg (-2.96 to 1.26) at month 1 and -9.58 mm Hg (-14.0 to -5.19)/-3.84 mm Hg (-6.22 to -1.47) at month 9. Δs in the post-exercise systolic/diastolic BP were -8.08 mm Hg (-14.2 to -2.01)/-2.07 mm Hg (-5.79 to 1.65) and -13.3 mm Hg (-19.9 to -6.75)/-4.62 mm Hg (-8.07 to -1.17), respectively. For completed shuttles, Δs at months 1 and 9 were 2.15 (-0.10 to 4.40) and 2.49 (-0.79 to 5.67), respectively. Δs in QoL were not significant. The correlations between the exercise-induced BP increases and the number of completed shuttles were similar in both groups. In conclusion, in patients at increased risk of developing HF, spironolactone reduced the pre- and post-exercise BP, but did not improve exercise capacity or QoL.

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Journal
Hypertension Research
Published
2024-09-06
DOI
https://doi.org/10.1038/s41440-024-01843-z
Primary Topic
Cardiovascular and exercise physiology
Type
article
Field-Weighted Citation Impact
0.00

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article

Effects of spironolactone on exercise blood pressure in patients at increased risk of developing heart failure: report from the HOMAGE trial

Job A.J. Verdonschot, Arantxa González, Johannes Petutschnigg, Nicolas Girerd et al.
Hypertension Research
Cardiovascular and exercise physiology
article

Effects of spironolactone on exercise blood pressure in patients at increased risk of developing heart failure: report from the HOMAGE trial

Job A.J. Verdonschot, Arantxa González, Johannes Petutschnigg, Nicolas Girerd, John G.F. Cleland, Patrick Rossignol, Faiez M. Zannad, De‐Wei An, Pierpaolo Pellicori, Jan A. Staessen, Beatrice Mariottoni, Stéphane Heymans, Andrew L. Clark, Fozia Ahmed, Tim S. Nawrot, Yan Li, Chen Liu, Fang‐Fei Wei, João Pedro Ferreira, Javier Muñiz, Joe Cuthbert
article en

Abstract

None of the spironolactone trials in heart failure (HF) assessed the blood pressure (BP) responses to exercise, while conflicting results were reported for exercise capacity. In the HOMAGE trial, 527 patients at increased HF risk were randomized to usual treatment with or without spironolactone (25-50 mg/day). The current substudy included 113 controls and 114 patients assigned spironolactone, who all completed the incremental shuttle walk test at baseline and months 1 and 9. Quality of life (QoL) was assessed by EQ5D questionnaire. Between-group differences (spironolactone minus control [Δs]) were analyzed by repeated measures ANOVA with adjustment for baseline and, if appropriate, additionally for sex, age and body mass index. Δs in the pre-exercise systolic/diastolic BP were -8.00 mm Hg (95% CI, -11.6 to -4.43)/-0.85 mm Hg (-2.96 to 1.26) at month 1 and -9.58 mm Hg (-14.0 to -5.19)/-3.84 mm Hg (-6.22 to -1.47) at month 9. Δs in the post-exercise systolic/diastolic BP were -8.08 mm Hg (-14.2 to -2.01)/-2.07 mm Hg (-5.79 to 1.65) and -13.3 mm Hg (-19.9 to -6.75)/-4.62 mm Hg (-8.07 to -1.17), respectively. For completed shuttles, Δs at months 1 and 9 were 2.15 (-0.10 to 4.40) and 2.49 (-0.79 to 5.67), respectively. Δs in QoL were not significant. The correlations between the exercise-induced BP increases and the number of completed shuttles were similar in both groups. In conclusion, in patients at increased risk of developing HF, spironolactone reduced the pre- and post-exercise BP, but did not improve exercise capacity or QoL.

Hypertension ResearchVol. 47(11)
Université Toulouse III - Paul Sabatier (FR), Janssen (Belgium) (BE), Inserm (FR), Sun Yat-sen University (CN), Universidade do Porto (PT), Mario Negri Institute for Pharmacological Research (IT), Manchester Academic Health Science Centre (GB), Maastricht University Medical Centre (NL), Glasgow Royal Infirmary (GB), Castle Hill Hospital (GB), Instituto de Salud Carlos III (ES), Ruijin Hospital (CN), University of Manchester (GB), London School of Hygiene & Tropical Medicine (GB), Centro de Investigación en Red en Enfermedades Cardiovasculares (ES), Azienda Usl 8 Arezzo (IT), St. Vincent's University Hospital (IE), The First Affiliated Hospital, Sun Yat-sen University (CN), Shanghai Institute of Hypertension (CN), Centre de Médecine Préventive (FR), Centro Hospitalar de Vila Nova de Gaia (PT), French Clinical Research Infrastructure Network (FR), Keele University (GB), Charité - Universitätsmedizin Berlin (DE), University of Glasgow (GB), Hasselt University (BE), Universidad de Navarra (ES), Université de Lorraine (FR), KU Leuven (BE)
Omron Healthcare, European Commission
Openalex Percentile: Top 71%
Cardiovascular and exercise physiology
DOIOpen Access PDFOpenAlex
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