Spironolactone in therapy of cardiovascular diseases Case report
Article Sidebar
Published:
Jun 30, 2015
Keywords:
spironolactone, aldosterone antagonists, hypertension, heart failure
Main Article Content
Abstract
The renin–angiotensin system (RAS) plays an important role in regulation of cardiovascular system. One of the main products of RAS is an minearalocorticosteroid hormone – aldosterone. It affects homeostasis of electrolytes and body water balance. An excessive activation of RAS, including an increased aldosterone production contribute to the development of hypertension and hypertension related end-organ damage. Beside angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) aldosterone antagonists are main molecules that pharmacologically inhibit RAS. The first use of aldosterone antagonist is dated on the mid-half of the 20th century. Initially drug was used as anti-hypokalemic agents and anti-edematous drug. Later it was shown that spironolactone is effective in therapy of essential hypertension and primary hyperaldosteronism. Spironolactone provides also beneficial hypotensive effect when added to polytherapy in patients with resistant hypertension. Drug reverses hypertension related complications, inhibits postinfarction heart remodeling and reduces heart muscle fibrosis. In randomized and placebo controlled studies spironolactone was shown to reduce risk of total and cardiovascular mortality and to decrease risk of sudden death in patients with heart failure.
Downloads
Download data is not yet available.
Article Details
How to Cite
Lewandowski , J. (2015). Spironolactone in therapy of cardiovascular diseases. Cardiology in Practice, 9(2), 46-54. Retrieved from https://journalsmededu.pl/index.php/kwp/article/view/1347
Issue
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
1. Rocha R., Funder J.W.: The pathophysiology of aldosterone in the cardiovascular system. Ann. N. Y. Acad. Sci. 2002; 970: 89-100.
2. Gomez Sanchez E.P.: What is the role of the central nervous system in mineralocorticoid hypertension? Am. J. Hypertens. 1991; 4: 374-381.
3. Lombes M., Alfaidy N., Eugene E. et al.: Prerequisite for cardiac aldosterone action. Mineralocorticoid receptor and 11 beta-hydroxysteroid dehydrogenase in the human heart. Circulation 1995; 92: 175-182.
4. Takeda Y., Miyamori I., Inaba S. et al.: Vascular aldosterone in genetically hypertensive rats. Hypertension 1997; 29: 45-48
5. Connell J.M., Davies E.: The new biology of aldosterone. J. Endocrinol. 2005; 186: 1-20.
6. Rocha R., Stier C.T. Jr., Kifor I. et al.: Aldosterone: a mediator of myocardial necrosis and renal arteriopathy. Endocrinology 2000; 141: 3871-3878.
7. Drelicharz Ł., Mikita J., Chabielska E., Chłopicki S.: Śródbłonkowe działanie aldosteronu – implikacje terapeutyczne płynące z badań podstawowych i klinicznych. Kardiol. Pol. 2005; 4(supl. 2): 409-419.
8. Hollenberg N.K.: Aldosterone in the development and progression of renal injury. Kidney Int. 2004; 4: 1-9.
9. Hyla-Klekot L., Pulcer B., Kokot F.: Układ renina–angiotensyna–aldosteron – nowe aspekty patogenetyczne i lecznicze. Aldosteron – ważny induktor szlaków patogenetycznych uszkadzających układ sercowo-naczyniowy i nerki. Arterial Hypertension 2007; 4(7): 357-363.
10. Farquharson C.A., Struthers A.D.: Aldosterone induces acute endothelial dysfunction in vivo in humans: evidence for an aldosterone induced vasculopathy. Clin. Sci. (Lond.) 2002; 103: 425-431.
11. Park J.B., Schiffrin E.L.: Cardiac and vascular fibrosis and hypertrophy in aldosterone-infused rats: role of endothelin-1. Am. J. Hypertens. 2002; 15: 164-169.
12. Zhang Z., Yu Y., Kang Y. et al.: Aldosterone acts centrally to increase brain renin-angiotensin system activity and oxidative stress in normal rats. Am. J. Physiol. Heart Circ. Physiol. 2008; 294: H1067-H1074.
13. Genest J.A.: Human arterial hypertension: a state of mild chronic hyperaldosteronism? Science 1956; 123: 503-505.
14. Laragh J.H., Ulick S., Januszewicz W. et al.: Aldosterone secretion and primary and malignant hypertension. J. Clin. Invest. 1960; 39: 1091-1106.
15. Vasan R.S., Evans J.C., Larson M.G. et al.: Serum aldosterone and the incidence of hypertension in nonhypertensive persons. N. Engl. J. Med. 2004; 351(1): 33-41.
16. Garthwaite S.M., McMahon E.G.: The evolution of aldosterone antagonists. Mol. Cell. Endocrinol. 2004; 217: 27-31.
17. Johnston L.C., Grieble H.G.: Treatment of arterial hypertensive disease with diuretics. V. Spironolactone, an aldosterone antagonist. Arch. Intern. Med. 1967; 119(3): 225-231.
18. Kreeft J.H., Larochelle P., Ogilvie R.I.: Comparison of chlorthalidone and spironolactone in low-renin essential hypertension. Can. Med. Assoc. J. 1983; 128: 31-34.
19. Karlberg B.E., Kagedal B., Tegler L., Tolagen K.: Renin concentrations and effects of propranolol and spironolactone in patients with hypertension. Br. Med. J. 1976; 1: 251-254.
20. Karlberg B.E., Kagedal B., Tegler L. et al.: Controlled treatment of primary hypertension with propranolol and spironolactone. A crossover study with special reference to initial plasma renin activity. Am. J. Cardiol. 1976; 37: 642-649.
21. Jeunemaitre X., Chatellier G., Kreft-Jais C. et al.: Efficacy and tolerance of spironolactone in essential hypertension. Am. J. Cardiol. 1987; 60: 820-825.
22. Batterink J., Stabler S.N., Tejani A.M., Fowkes C.T.: Spironolactone for hypertension. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD008169.
23. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J. Hypertens. 2013; 31: 1281-1357.
24. Sarafidis P.A., Bakris G.L.: Resistant Hypertension An Overview of Evaluation and Treatment. J. Am. Coll. Cardiol. 2008; 52: 1749-1757.
25. Calhoun D.A., Jones D., Textor S. et al.: Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008; 51: 1403-1419.
26. Graves J.W., Bloomfield R.L., Buckalew Jr. V.M.: Plasma volume in resistant hypertension: guide to pathophysiology and therapy Am. J. Med. Sci. 1989; 298: 361-365.
27. Nishizaka M.K., Zaman M.A., Calhoun D.A.: Efficacy of low-dose spironolactone in subjects with resistant hypertension. Am. J. Hypertens. 2003; 16: 925-930.
28. Engbaek M., Hjerrild M., Hallas J., Jacobsen A.: The effect of low-dose spironolactone on resistant hypertension. J. Am. Soc. Hypertens. 2010; 4(6): 290-294.
29. Vaclavik J., Sedlak R., Plachy M. et al.: Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT). Hypertension 2011; 57: 1069-1075.
30. Chapman N., Dobson J., Wilson S. et al.: Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension 2007; 49: 839-845.
31. Quinkler M., Stewart P.M.: Treatment of primary aldosteronism. Best. Pract. Res. Clin. Endocrinol. Metab. 2010; 24(6): 923-932.
32. Lacolley P., Labat C., Pujol A. et al.: Increased carotid wall elastic modulus and fibronectin in aldosterone-salt-treated rats: effects of eplerenone. Circulation 2002; 106(22): 2848-2853.
33. Rocha R., Chander P.N., Khanna K. et al.: Mineralocorticoid blockade reduces vascular injury in stroke-prone hypertensive rats. Hypertension 1998; 31: 451-458
34. Mahmud A., Feely J.: Aldosterone-to-renin ratio, arterial stiffness, and the response to aldosterone antagonism in essential hypertension. Am. J. Hypertens. 2005; 18(1): 50-55.
35. Savoia C., Touyz R.M., Amiri F., Schiffrin E.L.: Selective mineralocorticoid receptor blocker eplerenone reduces resistance artery stiffness in hypertensive patients. Hypertension 2008; 51(2): 432-439.
36. Bomback A.S., Muskala P., Bald E. et al.: Low-dose spironolactone, added to long-term ACE inhibitor therapy, reduces blood pressure and urinary albumin excretion in obese patients with hypertensive target organ damage. Clin. Nephrol. 2009; 72(6): 449-456.
37. Rachmani R., Slavachevsky I., Amit M. et al.: The effect of spironolactone, cilazapril and their combination on albuminuria in patients with hypertension and diabetic nephropathy is independent of blood pressure reduction: a randomized controlled study. Diabet. Med. 2004; 21(5): 471-475.
38. Kannel W.B.: Left ventricular hypertrophy as a risk factor: the Framingham experience. J. Hypertens. 1991; 9(supl. 2): 3-9.
39. Levy D., Garrison R.J., Savage D.D. et al.: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N. Engl. J. Med. 1990; 332: 1561-1566.
40. Sato A., Suzuki Y., Saruta T.: Effects of spironolactone and angiotensin-converting enzyme inhibitor on left ventricular hypertrophy in patients with essential hypertension. Hypertens. Res. 1999; 22: 17-22.
41. Sato A., Takane H., Saruta T.: High serum level of procollagen type III amino-terminal peptide contributes to the efficacy of spironolactone and angiotensin- converting enzyme inhibitor therapy on left ventricular hypertrophy in essential hypertensive patients. Hypertens. Res. 2001; 24: 99-104.
42. Sato A., Hayashi M., Saruta T.: Relative long-term effects of spironolactone in conjunction with an angiotensin-converting enzyme inhibitor on left ventricular mass and diastolic function in patients with essential hypertension. Hypertens. Res. 2002; 25(6): 837-842.
43. Cowie M.R., Mosterad A., Wood D.A. et al.: The epidemiology of heart failure. Eur. Heart J. 1997; 18: 208-225.
44. Pitt B., Zannad F., Remme W.J. et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N. Engl. J. Med. 1999; 341: 709-717.
45. Pitt B., Remme W., Zannad F. et al.: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N. Engl. J. Med. 2003; 348(14): 1309-1321.
46. Pitt B., White H., Nicolau J. et al.: Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J. Am. Coll. Cardiol. 2005; 46: 425-431.
47. The TOPCAT Investigators: Spironolactone for Heart Failure with Preserved Ejection Fraction. N. Engl. J. Med. 2014; 370: 1383-1392.
48. The Aldo-DHF Investigators: Effect of Spironolactone on Diastolic Function and Exercise Capacity in Patients With Heart Failure With Preserved Ejection Fraction. JAMA 2013; 309(8): 781-791.
2. Gomez Sanchez E.P.: What is the role of the central nervous system in mineralocorticoid hypertension? Am. J. Hypertens. 1991; 4: 374-381.
3. Lombes M., Alfaidy N., Eugene E. et al.: Prerequisite for cardiac aldosterone action. Mineralocorticoid receptor and 11 beta-hydroxysteroid dehydrogenase in the human heart. Circulation 1995; 92: 175-182.
4. Takeda Y., Miyamori I., Inaba S. et al.: Vascular aldosterone in genetically hypertensive rats. Hypertension 1997; 29: 45-48
5. Connell J.M., Davies E.: The new biology of aldosterone. J. Endocrinol. 2005; 186: 1-20.
6. Rocha R., Stier C.T. Jr., Kifor I. et al.: Aldosterone: a mediator of myocardial necrosis and renal arteriopathy. Endocrinology 2000; 141: 3871-3878.
7. Drelicharz Ł., Mikita J., Chabielska E., Chłopicki S.: Śródbłonkowe działanie aldosteronu – implikacje terapeutyczne płynące z badań podstawowych i klinicznych. Kardiol. Pol. 2005; 4(supl. 2): 409-419.
8. Hollenberg N.K.: Aldosterone in the development and progression of renal injury. Kidney Int. 2004; 4: 1-9.
9. Hyla-Klekot L., Pulcer B., Kokot F.: Układ renina–angiotensyna–aldosteron – nowe aspekty patogenetyczne i lecznicze. Aldosteron – ważny induktor szlaków patogenetycznych uszkadzających układ sercowo-naczyniowy i nerki. Arterial Hypertension 2007; 4(7): 357-363.
10. Farquharson C.A., Struthers A.D.: Aldosterone induces acute endothelial dysfunction in vivo in humans: evidence for an aldosterone induced vasculopathy. Clin. Sci. (Lond.) 2002; 103: 425-431.
11. Park J.B., Schiffrin E.L.: Cardiac and vascular fibrosis and hypertrophy in aldosterone-infused rats: role of endothelin-1. Am. J. Hypertens. 2002; 15: 164-169.
12. Zhang Z., Yu Y., Kang Y. et al.: Aldosterone acts centrally to increase brain renin-angiotensin system activity and oxidative stress in normal rats. Am. J. Physiol. Heart Circ. Physiol. 2008; 294: H1067-H1074.
13. Genest J.A.: Human arterial hypertension: a state of mild chronic hyperaldosteronism? Science 1956; 123: 503-505.
14. Laragh J.H., Ulick S., Januszewicz W. et al.: Aldosterone secretion and primary and malignant hypertension. J. Clin. Invest. 1960; 39: 1091-1106.
15. Vasan R.S., Evans J.C., Larson M.G. et al.: Serum aldosterone and the incidence of hypertension in nonhypertensive persons. N. Engl. J. Med. 2004; 351(1): 33-41.
16. Garthwaite S.M., McMahon E.G.: The evolution of aldosterone antagonists. Mol. Cell. Endocrinol. 2004; 217: 27-31.
17. Johnston L.C., Grieble H.G.: Treatment of arterial hypertensive disease with diuretics. V. Spironolactone, an aldosterone antagonist. Arch. Intern. Med. 1967; 119(3): 225-231.
18. Kreeft J.H., Larochelle P., Ogilvie R.I.: Comparison of chlorthalidone and spironolactone in low-renin essential hypertension. Can. Med. Assoc. J. 1983; 128: 31-34.
19. Karlberg B.E., Kagedal B., Tegler L., Tolagen K.: Renin concentrations and effects of propranolol and spironolactone in patients with hypertension. Br. Med. J. 1976; 1: 251-254.
20. Karlberg B.E., Kagedal B., Tegler L. et al.: Controlled treatment of primary hypertension with propranolol and spironolactone. A crossover study with special reference to initial plasma renin activity. Am. J. Cardiol. 1976; 37: 642-649.
21. Jeunemaitre X., Chatellier G., Kreft-Jais C. et al.: Efficacy and tolerance of spironolactone in essential hypertension. Am. J. Cardiol. 1987; 60: 820-825.
22. Batterink J., Stabler S.N., Tejani A.M., Fowkes C.T.: Spironolactone for hypertension. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD008169.
23. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J. Hypertens. 2013; 31: 1281-1357.
24. Sarafidis P.A., Bakris G.L.: Resistant Hypertension An Overview of Evaluation and Treatment. J. Am. Coll. Cardiol. 2008; 52: 1749-1757.
25. Calhoun D.A., Jones D., Textor S. et al.: Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension 2008; 51: 1403-1419.
26. Graves J.W., Bloomfield R.L., Buckalew Jr. V.M.: Plasma volume in resistant hypertension: guide to pathophysiology and therapy Am. J. Med. Sci. 1989; 298: 361-365.
27. Nishizaka M.K., Zaman M.A., Calhoun D.A.: Efficacy of low-dose spironolactone in subjects with resistant hypertension. Am. J. Hypertens. 2003; 16: 925-930.
28. Engbaek M., Hjerrild M., Hallas J., Jacobsen A.: The effect of low-dose spironolactone on resistant hypertension. J. Am. Soc. Hypertens. 2010; 4(6): 290-294.
29. Vaclavik J., Sedlak R., Plachy M. et al.: Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT). Hypertension 2011; 57: 1069-1075.
30. Chapman N., Dobson J., Wilson S. et al.: Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension 2007; 49: 839-845.
31. Quinkler M., Stewart P.M.: Treatment of primary aldosteronism. Best. Pract. Res. Clin. Endocrinol. Metab. 2010; 24(6): 923-932.
32. Lacolley P., Labat C., Pujol A. et al.: Increased carotid wall elastic modulus and fibronectin in aldosterone-salt-treated rats: effects of eplerenone. Circulation 2002; 106(22): 2848-2853.
33. Rocha R., Chander P.N., Khanna K. et al.: Mineralocorticoid blockade reduces vascular injury in stroke-prone hypertensive rats. Hypertension 1998; 31: 451-458
34. Mahmud A., Feely J.: Aldosterone-to-renin ratio, arterial stiffness, and the response to aldosterone antagonism in essential hypertension. Am. J. Hypertens. 2005; 18(1): 50-55.
35. Savoia C., Touyz R.M., Amiri F., Schiffrin E.L.: Selective mineralocorticoid receptor blocker eplerenone reduces resistance artery stiffness in hypertensive patients. Hypertension 2008; 51(2): 432-439.
36. Bomback A.S., Muskala P., Bald E. et al.: Low-dose spironolactone, added to long-term ACE inhibitor therapy, reduces blood pressure and urinary albumin excretion in obese patients with hypertensive target organ damage. Clin. Nephrol. 2009; 72(6): 449-456.
37. Rachmani R., Slavachevsky I., Amit M. et al.: The effect of spironolactone, cilazapril and their combination on albuminuria in patients with hypertension and diabetic nephropathy is independent of blood pressure reduction: a randomized controlled study. Diabet. Med. 2004; 21(5): 471-475.
38. Kannel W.B.: Left ventricular hypertrophy as a risk factor: the Framingham experience. J. Hypertens. 1991; 9(supl. 2): 3-9.
39. Levy D., Garrison R.J., Savage D.D. et al.: Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N. Engl. J. Med. 1990; 332: 1561-1566.
40. Sato A., Suzuki Y., Saruta T.: Effects of spironolactone and angiotensin-converting enzyme inhibitor on left ventricular hypertrophy in patients with essential hypertension. Hypertens. Res. 1999; 22: 17-22.
41. Sato A., Takane H., Saruta T.: High serum level of procollagen type III amino-terminal peptide contributes to the efficacy of spironolactone and angiotensin- converting enzyme inhibitor therapy on left ventricular hypertrophy in essential hypertensive patients. Hypertens. Res. 2001; 24: 99-104.
42. Sato A., Hayashi M., Saruta T.: Relative long-term effects of spironolactone in conjunction with an angiotensin-converting enzyme inhibitor on left ventricular mass and diastolic function in patients with essential hypertension. Hypertens. Res. 2002; 25(6): 837-842.
43. Cowie M.R., Mosterad A., Wood D.A. et al.: The epidemiology of heart failure. Eur. Heart J. 1997; 18: 208-225.
44. Pitt B., Zannad F., Remme W.J. et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N. Engl. J. Med. 1999; 341: 709-717.
45. Pitt B., Remme W., Zannad F. et al.: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N. Engl. J. Med. 2003; 348(14): 1309-1321.
46. Pitt B., White H., Nicolau J. et al.: Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J. Am. Coll. Cardiol. 2005; 46: 425-431.
47. The TOPCAT Investigators: Spironolactone for Heart Failure with Preserved Ejection Fraction. N. Engl. J. Med. 2014; 370: 1383-1392.
48. The Aldo-DHF Investigators: Effect of Spironolactone on Diastolic Function and Exercise Capacity in Patients With Heart Failure With Preserved Ejection Fraction. JAMA 2013; 309(8): 781-791.