Effect of spironolactone on diastolic function in hypertensive left ventricular hypertrophy

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Resistant hypertension (HTN) is associated with left ventricular hypertrophy (LVH) and diastolic dysfunction.
• Mineralocorticoid receptor antagonists like spironolactone can reverse LVH.
• The effect of spironolactone on pre-clinical diastolic dysfunction in HTN is not well understood.

Purpose of the Study:

• To investigate the impact of spironolactone on pre-clinical diastolic dysfunction in patients with resistant hypertension and LVH.
• To assess changes in diastolic function and collagen turnover markers with spironolactone therapy.
• To explore whether aldosterone levels influence the response to spironolactone.

Main Methods:

• Cardiac magnetic resonance with tissue tagging was used to assess diastolic function at baseline, 3, and 6 months in 34 patients.
• Serum markers of collagen turnover were measured at baseline and 6 months.
• Patients were stratified based on baseline aldosterone levels (high vs. normal).

Main Results:

• Patients exhibited pre-clinical diastolic dysfunction at baseline, indicated by reduced E/A ratio, mitral annular velocity, and strain rates compared to controls.
• Spironolactone treatment led to a significant reduction in left ventricular mass index.
• No significant improvements in diastolic filling, relaxation parameters, or collagen markers were observed after 6 months of spironolactone therapy, regardless of aldosterone status.

Conclusions:

• Resistant hypertension with LVH is linked to significant pre-clinical diastolic dysfunction.
• Short-term spironolactone therapy effectively reduces LVH but does not improve pre-clinical diastolic function in these patients.
• Aldosterone status did not appear to affect the lack of improvement in diastolic function.