Effects of spironolactone on exercise blood pressure in patients at increased risk of developing heart failure: report from the HOMAGE trial - Pôle scientifique Biologie, Médecine, Santé
Article Dans Une Revue Hypertension Research Année : 2024

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

Fang-Fei Wei (1, 2) , Pierpaolo Pellicori (3, 4, 5) , João Pedro Ferreira (6, 7) , Arantxa González (8, 9, 10, 11) , Beatrice Mariottoni (12) , De-Wei An (13, 14, 15, 16) , Job a J Verdonschot (17) , Chen Liu (1) , Fozia Z Ahmed (18) , Johannes Petutschnigg (19, 20, 21) , Patrick Rossignol (22, 23, 24, 25, 26) , Stephane Heymans (17) , Joe Cuthbert (27, 28) , Nicolas Girerd (22, 23, 24, 25, 26) , Andrew L Clark (27, 28) , Yan Li (29, 15, 16) , Tim S Nawrot (30, 31) , Javier Díez (8, 9, 11) , Faiez Zannad (22, 23, 24, 25, 26) , Cleland John G F (5) , Staessen Jan A (2, 16, 31, 15)
1 The First Affiliated Hospital of Sun Yat-sen University
2 Non-Profit Research Association Alliance for the Promotion of Preventive Medicine (APPREMED)
3 Robertson Centre for Biostatistics & Clinical Trials Unit
4 Institute of Health and Wellbeing
5 University of Glasgow
6 Centro Hospitalar Vila Nova de Gaia/Espinho
7 Universidade do Porto = University of Porto
8 UNAV - Universidad de Navarra [Pamplona]
9 IdiSNA - Navarra Institute for Health Research / Instituto de Investigación Sanitaria de Navarra
10 CIBERCV - Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares [Spain]
11 Institute of Health Carlos III
12 Cortona Hospital
13 Shanghai Institute of Hypertension
14 Non-Profit Research Institute Alliance for the Promotion of Preventive Medicine, Mechelen (APPREMED)
15 Ruijin Hospital [Shanghai, Chine]
16 Shanghai Jiaotong University School of Medicine
17 MUMC - Maastricht University Medical Centre
18 University of Manchester [Manchester]
19 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
20 BIH - Berlin Institute of Health
21 DZHK - German Center for Cardiovascular Research
22 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
23 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
24 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
25 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
26 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
27 University of Hull [United Kingdom]
28 Castle Hill Hospital
29 Shanghai Key Laboratory of Hypertension
30 UHasselt - Hasselt University
31 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
Fozia Z Ahmed
Stephane Heymans

Résumé

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.
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hal-04694768 , version 1 (11-09-2024)

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Fang-Fei Wei, Pierpaolo Pellicori, João Pedro Ferreira, Arantxa González, Beatrice Mariottoni, et al.. Effects of spironolactone on exercise blood pressure in patients at increased risk of developing heart failure: report from the HOMAGE trial. Hypertension Research, 2024, Online ahead of print. ⟨10.1038/s41440-024-01843-z⟩. ⟨hal-04694768⟩
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