Always nice to write an editorial together with partner-in-crime @kevin_damman! We dig into the question: "Is spironolactone a disease-modifying drug or diuretic in #HFpEF?" @ESC_Journals
onlinelibrary.wiley.com/doi/epdf/10.10…
Comment on:
onlinelibrary.wiley.com/doi/abs/10.100…
onlinelibrary.wiley.com/doi/epdf/10.10…
Comment on:
onlinelibrary.wiley.com/doi/abs/10.100…
Key points:
1. Spironolactone = most cost-effective drug in #HFrEF
2. Considering modest diuretic effects with 25-50mg, likely due to pleiotropic effects (Figure)
3. Natriuretic effects increase with dosing up to 600 mg (cirrhosis)
4. Average TOPCAT ~ RALES dose
1. Spironolactone = most cost-effective drug in #HFrEF
2. Considering modest diuretic effects with 25-50mg, likely due to pleiotropic effects (Figure)
3. Natriuretic effects increase with dosing up to 600 mg (cirrhosis)
4. Average TOPCAT ~ RALES dose
5. Current study shows marginal (<1%) & short-term (first 8 months) effect on weight loss in TOPCAT Americas.
Spiro patients gradually had lower diuretic need and RAS blockers more frequently withdrawn.
6. Beneficial effects of spironolactone independent of these trends
Spiro patients gradually had lower diuretic need and RAS blockers more frequently withdrawn.
6. Beneficial effects of spironolactone independent of these trends
Overall, results most likely reflecting slow improvement in underlying HFpEF over time due to non-diuretic effects. Effects on natriuresis might be more pronounced than on diuresis, but were unfortunately not assessed.
Finally, MRA should come before RAS blocker in HFpEF R/
Finally, MRA should come before RAS blocker in HFpEF R/
