Aldosterone Antagonist Improves Diastolic Function in Essential Hypertension

Grandi, Anna Maria; Imperiale, Daniela; Santillo, R.; Barlocco, E.; Bertolini, A; Guasti, Luigina; Venco, Achille

doi:10.1161/01.hyp.0000036399.80194.d8

Cited by 83 publications

(45 citation statements)

References 38 publications

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“…An inverse relationship of plasma aldosterone with E/A ratio was initially reported in treated patients with hypertension and LV hypertrophy 13 and improvement of diastolic function associated with reduction of LV mass was obtained with spironolactone in hypertensive patients with LV hypertrophy who were already treated with angiotensinconverting enzyme inhibitors and calcium-channel blockers. 30 Conversely, a recent study of hypertensive patients with preclinical LV diastolic dysfunction has reported no change of E/A ratio and diastolic function assessed by MRI after addition of spironolactone to previous antihypertensive treatment, despite significant reduction in LV mass.…”

Section: Discussionmentioning

confidence: 96%

Plasma Aldosterone and Left Ventricular Diastolic Function in Treatment-Naïve Patients With Hypertension

et al. 2015

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Diastolic heart failure is detected with increasing frequency in patients with hypertension 1 and is anticipated by changes in left ventricular (LV) filling properties that reflect stiffening of the ventricular wall. These changes in diastolic function can occur even in the absence of hypertension-related LV hypertrophy and are associated with increased hospitalization rate and mortality.2 Therefore, identification of early LV diastolic abnormalities is critical in patients with high blood pressure to prevent subsequent cardiac functional deterioration heralding cardiac insufficiency.3 Conventional echocardiographic techniques cannot detect early changes of diastolic function in a relevant proportion of patients, 4 but pulsed tissue-Doppler imaging (TDI) with measurement of myocardial velocities at several segments of the LV wall permits more sensitive 5 and reproducible 6 detection of diastolic dysfunction. In addition to an increased blood pressure-related cardiac workload, other factors could contribute to the development of structural and functional abnormalities of the heart in patients with hypertension. Evidence obtained in experimental animal studies indicates that inappropriately elevated aldosterone levels and activation of mineralocorticoid receptors (MR) induce profibrotic and hypertrophic responses in the heart. 7-10 Also, studies conducted in patients with primary aldosteronism have consistently reported abnormal LV diastolic properties in association to excess LV hypertrophy in comparison with matched patients with primary hypertension.11,12 However, results of studies that examined the possible contribution of plasma aldosterone levels to LV diastolic dysfunction in primary hypertension were inconsistent 13,14 and also studies that investigated the effects of MR antagonists on LV diastolic function and clinical outcomes in patients with heart failure and preserved ejection fraction reported controversial results. [15][16][17][18] Inconsistencies could be attributed to the use of conventional echocardiography in most of these studies and, most important, to possible interference of drugs used to treat hypertension or heart failure. 19 The aim of this study was, Abstract-Aldosterone has hypertrophic and profibrotic effects on the heart. The relationship between plasma aldosterone levels and left ventricular diastolic function in hypertension, however, is unclear. The aim of this study was to examine this relationship in treatment-naïve hypertensive patients free of comorbidities that could affect left ventricular diastolic filling properties. In 115 patients with primary hypertension who were eating a standard diet and 100 matched normotensive controls, we measured plasma aldosterone and active renin levels and performed both conventional echocardiography and tissue-Doppler imaging for assessment of left ventricular diastolic function. Left ventricular hypertrophy was found in 21% of hypertensive patients, and diastolic dysfunction was detected in 20% by conventional echocardiography and in 58% by ...

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Section: Discussionmentioning

confidence: 96%

Plasma Aldosterone and Left Ventricular Diastolic Function in Treatment-Naïve Patients With Hypertension

et al. 2015

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“…In essential hypertension, a low dose of the aldosterone antagonist canrenone added to antihypertensive treatment has been shown significantly to improve left ventricular diastolic function [94]. This improvement, not accounted for by changes in blood pressure and left ventricular mass, can be ascribed to a direct action of the drug on the myocardium.…”

Section: Interaction With Aldosteronementioning

confidence: 99%

“…Med Clin N Am 88 (2004) [83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] Under certain circumstances, a regression of fibrous tissue occurs after the repair process has been completed. This is related to fibrillar collagen degradation by matrix metalloproteinases [19,20].…”

mentioning

confidence: 99%

Fibrosis in hypertensive heart disease: role of the renin-angiotensin-aldosterone system

González

López

Dı́ez

2004

Medical Clinics of North America

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“…Furthermore, MRAs have been shown to improve CV outcomes in subjects with HFREF 15, 16, 17, 18, 19. Several studies have evaluated the efficacy and safety of MRAs in patients with asymptomatic LVDD20, 21, 22, 23, 24 as well as established HFPEF 25, 26, 27, 28, 29, 30…”

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confidence: 99%

Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta‐Analysis and Systematic Review

Pandey

Garg

Matulevicius

et al. 2015

JAHA

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BackgroundThere has been an increasing interest in use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with preserved ejection fraction (HFPEF). However, a comprehensive evaluation of MRA effects on left ventricular (LV) structure and function in these patients is lacking. In this meta‐analysis, we evaluated the effects of MRAs on LV structure and function among patients with diastolic dysfunction or HFPEF.Methods & ResultsRandomized, controlled clinical trials evaluating the efficacy of MRAs in patients with diastolic dysfunction or HFPEF were included. The primary outcome was change in E/e’, a specific measure of diastolic function. Secondary outcomes included changes in other measures of diastolic function, LV structure, surrogate markers for myocardial fibrosis (carboxy‐terminal peptide of procollagen type I [PICP] and amino‐terminal peptide of pro‐collagen type‐II [PIIINP]), blood pressure, and exercise tolerance. In the pooled analysis, MRA use was associated with significant reduction in E/e’ (weighted mean difference [WMD] [95% confidence interval {CI}]: −1.68 [−2.03 to −1.33]; P<0.0001) and deceleration time (WMD [95% CI]: −12.0 ms [−23.3 to −0.7]; P=0.04) as compared with control, suggesting and improvement in diastolic function. Furthermore, blood pressure and levels of PIIINP and PICP were also significantly reduced with MRA therapy with no significant change in LV mass or dimensions.Conclusion MRA therapy in patients with asymptomatic diastolic dysfunction or HFPEF is associated with significant improvement in diastolic function and markers of cardiac fibrosis without a significant change in LV mass or dimensions.

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Aldosterone Antagonist Improves Diastolic Function in Essential Hypertension

Cited by 83 publications

References 38 publications

Plasma Aldosterone and Left Ventricular Diastolic Function in Treatment-Naïve Patients With Hypertension

Plasma Aldosterone and Left Ventricular Diastolic Function in Treatment-Naïve Patients With Hypertension

Fibrosis in hypertensive heart disease: role of the renin-angiotensin-aldosterone system

Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta‐Analysis and Systematic Review

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