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Spironolactone impairs endothelial function and heart rate variability in patients with type 2 diabetes

J I Davies1, M Band, A Morris

  • 1Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee, Scotland. j.i.davies@dundee.ac.uk

Diabetologia
|September 15, 2004
PubMed

Insights

Spironolactone worsened endothelial function and heart rate variability in type 2 diabetes patients. This drug is not recommended for diabetic patients without heart failure due to adverse effects on glycaemic control and angiotensin II levels.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Background:

  • Aldosterone blockade reduces mortality in heart failure patients, improving endothelial function and heart rate variability.
  • Angiotensin II withdrawal benefits diabetic patients.
  • The study investigated spironolactone's effects on diabetic patients' prognostic markers.

Purpose of the Study:

  • To evaluate the effects of spironolactone on endothelial function and heart rate variability in patients with type 2 diabetes mellitus.
  • To assess spironolactone's impact on glycaemic control (HbA1c) and plasma angiotensin II levels.

Main Methods:

  • A randomized, double-blind trial involving 42 type 2 diabetes patients.
  • Forearm venous occlusion plethysmography assessed endothelial function.
  • Heart rate variability, HbA1c, and plasma angiotensin II levels were measured after 1 month of spironolactone or placebo.

Main Results:

  • Spironolactone significantly worsened endothelial function, decreasing forearm blood flow response to acetylcholine.
  • Heart rate variability parameters deteriorated, with increased low frequency:high frequency ratio.
  • HbA1c and plasma angiotensin II levels increased significantly with spironolactone treatment.

Conclusions:

  • Spironolactone negatively impacts endothelial function and heart rate variability in type 2 diabetes patients.
  • Worsening glycaemic control and increased angiotensin II levels may explain these adverse effects.
  • Spironolactone is not recommended for diabetic patients without heart failure.
Abstract

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