Title : Assessment of treatment with spironolactone on right ventricular function in patients with type 1 pulmonary hypertension
Despite evidence showing the effect of vasoactive hormones including aldosterone in pulmonary arterial hypertension (PAH) pathophysiology, few clinical reports are available concerning the effect of PAH treatment with aldosterone antagonists. Therefore, in this study, we evaluate the effect of PAH treatment with aldosterone receptor antagonist drug (Spironolactone) in case of right ventricular systolic and diastolic function and clinical findings
Materials & Methods: This study was accomplished as a double-blinded randomized clinical trial with control group. All patients with PAH referring to Imam Reza Hospital, Mashhad since July 23, 2016, to July 23, 2017 were included to this study. Patients randomly received standard treatment (Tadalafil 10-20 mg once daily plus Bosentan 125 mg once or twice daily) or standard treatment in addition to spironolactone (25 mg once daily) for 3 months. Before and 3 months after the study, patients were assessed in terms of clinical (6-minute walking distance, right ventricular diameter [6MWD] and New York Heart Association [NYHA] function class) and echocardiographic (mid-right ventricle diameter, pulmonary arterial pressure [PAP], and right ventricle function based on TAPSE) variables. After data collection, data were analysed using SPSS version 16 and p<0.05 was considered as significant level.
Results: Overall, 45 patients (23 patients in “intervention group” and 22 patients in “control group” [35.1±7.57 and 34.6±9.54 years, respectively; p=0.83]) completed treatment and follow-up period. Only 3 patients were men (2 patients in intervention and 1 patient in control groups). After completing 3-month period of study, no significant difference was observed in 6MWD, mid-right ventricle diameter, PAP and NYHA function class (p=0.834, p=0.133, p=0.938, p=0.084, and p=0.284). However, TAPSE in intervention group was measured significantly more than control group (p=0.041). On the other hand, no significant difference was seen in any of evaluated variables, between before and after study periods in control and intervention groups (p>0.05). Additionally, in comparison of amount of difference after and before intervention, no significant difference was observed in none of two groups (p>0.05).
Conclusion: Altogether, no significant difference was observed between any of studied clinical and echocardiographic variables, before and after study, in none
Audience Takeaway Notes
- They find that the administration of spironolactone in a patient with pulmonary hypertension does not have a therapeutic role
- It is effective in the correct treatment of patients with pulmonary hypertension
- Treatment of patients with pulmonary hypertension is always a medical challenge